HomeMy WebLinkAboutS2016-0193 - Permit Application12�5� t�
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION S,2DI�- DIEj j
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
SWIMMING POOL
Check Appropriate box for Applicant
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_ ESTIMATED $ VALUATION
POOL FENCING DRAINAGE]
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
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. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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ADDRESS
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CONTRACTOR'S E-MAIL ADDRESS
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Q A'c-
CITY STATE ZIP
PHONE
OFFICE USE ONLY
PERMIT NO. S to )
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms%Pool spa appl (rev3-04).xls