HomeMy WebLinkAboutS2019-0101 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION 1308-2019
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V 4 CITY OF NEWPORT BEACH
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BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
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2. DESCRIPTION OF WOf� e"J SQ
SWIMMING POOL ❑
Check Appropriate box for
TRACT
�_ ESTIMATED $ VALUATION
POOL FENCING ❑
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I OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
IPHONE NO.
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5. CONTRACTOR'S NAME
BUSINEvSS�LICENSE
STATE LICENSE
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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Y STATE ZIP
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PHONE
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OFFICE USE ONL
PERMIT NOY�� �¢ CAj `° +1
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PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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