HomeMy WebLinkAboutS2020-0016 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS) --- __
PDC 6:50��pL
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF
SWIMMING POOL I�
,,.,
ESTIMATED $ VALUATION H�/ow
SPA POOL FENCING ❑ DRAINAGE
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
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J/ 4
ADDRESS
OWNER'S E-MAIL ADDRESS
33
CITY STATE ZIP
PHONES NO.
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JT �� 1 693
7
41`L (�15-
n 4. ENGINEER'S NAME LAST FIRST
LICENSE NO,
ADDRESS
ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
IPHONE NO.
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430 -61 l "�
F1 5. CONTRACTOR'S NAME
BBUUSINESSLIICENSE
BUSINESS
STATE LICENSE
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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LTY STATE ZIP
PHONE NO.
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OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO. opal •ZXL•
POOL PIC FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls