HomeMy WebLinkAboutS2013-0038 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
m , ` BUILDING DEPARTMENT
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1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORKL__J'
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____4 F____ ESTIMATED $VALUATION (-- kJ
SWIMMING POOL M�� SPA Lam' Pp
Check Appropriate box for ADDlicant
3. OWNER'S NA E LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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CIT STATE ZIP
4
PHONE NO.
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
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ENGINEER'S E-MAIL ADDRESS
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ACITY j STATE ZIP
PHONE NO.
CON R(A�CTTOgR'S NAME / ^
BUSINESS LICENSE
STATE LICENSE
No.J f s Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CI /STATE ZIP
2-2 19
PHONE NO.
7 �I
3
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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