HomeMy WebLinkAboutS2019-0017 - Permit ApplicationSZ0I9 - 00 11
4 a"° WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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�* CITY OF NEWPORT BEACH
BUILDING DIVISION
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1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL ❑ SPA M
Check Appropriate box for Applicant
ESTIMATED $ VALUATION
POOL FENCING ❑
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
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17AL
ADDRESS
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OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
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PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
N. Avew
ENGINEER'S E-MAIL ADDRESS
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1201
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CITY STATE ZIP
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PHONE)O.
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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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CITY STATE ZIP
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HONE NY.
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;E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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