HomeMy WebLinkAboutS2019-0043 - Permit ApplicationwWnry" WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
,= CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LOT
S-4,00 - 0043
2. DESCRIPTION OF WORK < �( V �,-) G� U r�
ESTIMATED $ VALUATION AD— I
SWIMMING POOL ❑ SPA POOL FENCING ❑ DRAINAGE
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3. OWNER'S NAME
LAST
FIRST
y�
ADDRESS
OWNER'S E-MAIL ADDRESS
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Cl Y
STATE
ZIP
PHONE NO.
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FIRST
LICENSE NO.
r4.ENGIENEER'SAME
ENGINEER'S EMAIL ADDRESS
STATE
ZIP
PHONE NO.
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❑�5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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No'/3rZ� Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
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FFOFFICEUSEONLY
NO.HECK
NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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