HomeMy WebLinkAboutS2023-0080 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDR'EISS (NOT MAILIINNG ADDRESS)
LOT BLOCK TRACT
2. DESCRIPTION OF WORK ' f N� i S
SWIMMING POOL ❑ SPA
ESTIMATED $ VALUA
POOL FENCING ❑
0
v
DRAINAGE ❑
Check Appropriate box for Applicant 11
3. OWNER'S NAME
ADDRESS
OWNER'S E- AIL ADDRESS
/
7J 4 ' 1. (i- t„ q 1 n
CITY
STATE
ZIP
PHONE NO.
4. ENGINEER'S NAME LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
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5. CONTRACTORS NAME 11
BUSINESS LICENSE S ATE LICENSE
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY
at
STATE
ZIP
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PHONE NO.
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:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
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DRAINAGE P/C FEE $
Farms\Pool spa appl (rev3-04).xls