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WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
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BUILDING DIVISION
PLEASE PRINT OR TYPE L
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF
ESTIMATED $ VALUATION 2
SWIMMING POOL [9 SPA ® POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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STATE ZIP
PHONE NO. i
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
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ADDRESS
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CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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OFFICE
USE ONLY
PERMIT NO. Q l� � - -► i�J
PLAN CHECK NO. �' ZOIC
POOL P/C FEE $ f� y
DRAINAGE P/C FEE $Cy
Forms\Pool spa appl (rev3-04).xls