HomeMy WebLinkAboutS2016-0187 - Permit ApplicationSLj�o® OV
04-1,
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION _
LOT BLOCK IV 0 TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL ❑ SPA
Check Appropriate box for Applicant
ESTIMATED $ VALUATION
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3. OWR'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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5. CONTRACTOR'S NAME
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BUSINESS LICENSE
STATE LICENSE
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No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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ITY STATE ZIP
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PHONE NO.
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CE USE ONLY
PERMIT N0.
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PLAN CHECK N0.
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POOL P/C FEE $
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DRAINAGE P/C FEE $
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