HomeMy WebLinkAboutP2019-0086 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION5�
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
I u ti3 6
ftv
LEGAL DESCRIPTION
LOT
BLOCK
TRACT
2.DESCRIPTION OFWORK _
ESTIMATED $ VALUATION
SWIMMING POOL ❑
SPA [j)
,
POOL FENCING ❑ DRAINAGE Lj,/
Check Appropriate box for Applicant
3..O�WNER'S NAME
LAST
FIRST
, C/rtl
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
l
rt
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
r
A. c-Vw�
e' r
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
LICENSE ST TE LICENSE
G� ``
:BUSINESS
((��
ADDRESS
IIIIa. Class
CONTRACTOR'S E-MAIL ADDRESS
27
CITY
STATE
ZIP
PHO ENO.
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls