HomeMy WebLinkAboutS2021-0076 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION C ZU Z' U U-7t
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK GO L- VU()EL-
0 ESTIMATED $ VALUATION
SWIMMING POOL ®' SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check Anorooriate box for Anolicant
3. OWNER'S NAME LAST
FIRST
C 0R � �R D
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST
FIRST
LICENSE NO.
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ADD
ENGINEER'S E-MAIL ADDRESS
11
C
CITY
STATE)
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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No.4'-i 3-1 S Class 3
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY
STATE ZIP
PHONE NO.
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C-N
-2 �C -1
1-1 1 " - 313 -1
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
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DRAINAGE P/C FEE $ T3C�U7y �j C�
Forms\Pool spa appl (rev3-04).xls