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WO COR POOL COMBINATION PERMIT APPLICATION
ITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (Nor LI ADDRESS)
LEGAL
LOT
BLOCK
TRACT
2. DESCRIPTION OF WORK 4nn1 Upy,R 1�,� r a OLO Sl•'n n Pf 3 Mw Dot Wei E.YCmb' iwm�_ enOk
Qv. ��1 IVP,N \tn.�� S ;� �Qw oru�n 1 avlte ESTIMATED $ VALUATION LA01 000
SWIMMING POOL �J SPA IS POOL FENCING ❑ DRAINAGE ❑
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3. OWNER'S NAME
LAST
FIRST . 62 .
OM
1,v
ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY
STATE
ZIFF
PHONE NO.
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4.
ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDREeS
CITY
STATE
ZIP
PHONE NO.
5.
CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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No. Class
CONTRACTOR'S E-MAIL ADDRESS
`AAD�DRESS, 1 / ,� ` �j,
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CITY
STATE
ZIP
PHONE NO.
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Farms\Pool spa appl (rev3-04).xls
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