HomeMy WebLinkAboutS2019-0067 - Permit ApplicationG WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DEf CRI TION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK /L lo
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ESTIMATED $ VALUATION
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SWIMMING POOL ❑ SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER '$ f\IAME LAST
_,' FIRST
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zj ,wj
/
C
ADDRESSOWNER'S
E-MAIL ADDRESS
d(ZI —, J>\
CITY STATEZIP
70NE NO.
4. ENGINEER'S NAME LAST
FIRST
&CENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY •. STATE
ZIP
PHONE NO.
f"1 5. QONTRACCTORAME
BUSINESS LICENSE
STATE LICENSE /Q
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No. �61y�LOk Classf✓
CONTRACTOR'S E-MAIL ADDRESS
7ADDRESS
ITY STATE
ZIP
PHONE NO.
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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