HomeMy WebLinkAboutS2023-0105 - Permit Application (3)WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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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
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NG POOLX
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Check AADrODriate box for Applicant
POOL FENCING ❑
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY / r �/Sn}TATE ( ZIP
PHONE NO. Q
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4. ENGINEER'S N✓✓✓AME LAST FIRST,
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
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❑ 5. CONTRACTOR'S NAME
BUSINESS LICENSE
ATE LICENSE
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
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 $
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