HomeMy WebLinkAboutS2018-0152 - Permit ApplicationE2.D 1 V 015
oF�$wR r WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
PLEASE PRINT OR TYPE BUILDING DIVISION
1. PROJECT ADDRESS (Nor MAILING q ESS)
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LOT BLOCK
2. DESCRIPTION OF WORK
SWIMMING POOL ❑ SPA P� POOL FENCING ❑
Check Appropriate box for Applicant
f'I 3. OWNER'S NAMF
DRAINAGE ❑
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ADDRESS
rf�\\ OWNER'S E-MAIL ADDRESS
CITY
STATEZIP PHONE NO.
❑ 4. ENGINEER'S NA E
LICENSE NO.
LAST FIRSTJADDRE
ADDRESS r
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ENGINRESS (0Cw�
CITY
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BUSINSTAT LICENSEQ
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Class
CONTRDDRESSE
ONE N0.
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OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO. _
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POOL P/C FEE $
DRAINAGE P/C FEE $
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