HomeMy WebLinkAboutS2019-0138 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASt 11KIN I UK I TrM
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
2. DESC IPTION OF WORK t'J l w S? f W 6-'C&
oo,�- ESTIMATED $ VALUATION
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SWIMMING POOL ❑ SPA �/ POOL FENCING ❑ DRAINAGE
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3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
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ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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5. CONTRACTOR'S NAME
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STATE LICENSE
`BUSINESS
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CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIPPHONE
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NO.
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