HomeMy WebLinkAboutS2020-0102 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
3, CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
ESTIMATED $ VALLIATION-A 10,2 6 B
�a
SWIMMING POOL ❑ SPA(12 POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
rl 3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
el
CITY STATE ZIP
PHONE NO.
L)
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE —[TATE
LICENSE
�[� V �•� �'I �"�•�
o?/�Glass -
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
!_Z 7 �, - _-, A)
CITY STATE ZZIP
IPHONE NO.
/
�E USE ONLY
PERMIT NO. 5Zo 7� o to
PLAN CHECK NO. t�Gi m
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xis