HomeMy WebLinkAboutX2021-1886 - Permit Application5'" P'" WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
wel CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK
TRACT
2. DESCRIPTION OF WORK 6 0�C1S "i P, y-
SWIMMING POOL ,N SPA
Check ADorooriate box for Annficanr
_ ESTIMATED $ VALUATION 7/e il,Gz-
POOL FENCING ❑ DRAINAGE ❑
❑ 3. OWNER'S NAME
FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY
STATE
ZIP
PHONE NO.
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C�
CIZNEER'S
NAME
rADDRESS
LASTFIRST
LICENSE NO
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP PHONE NO,
5. CONTRACTOR'S NAME
BUSINESSS/LIICEcNr,SSE STATE LICENSE
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ADDRESS
/ V No. G 5 Class
CONTRACTOR'S E-MAIL ADDRESS
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CITY
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STATE
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ZIP
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PHONE NO.
OFFICE USE ONLY
PERMIT NO.
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PLAN CHECK NO.
POOL P/C FEE $ �_
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DRAINAGE P/C FEE $
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