HomeMy WebLinkAboutS2020-0049 - Permit ApplicationS)A210--Goya
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
01
,= CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT % BLOCK TRACT J l
2. DESCRIPTION OF WORK r Lel 4�Qj?N, I
e
ESTIMATED $ VALUATION
SWIMMING POOL SPA(21 POOL FENCING ❑ DRAINAGE
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DRAINAGE P/C FEE $
Forms\Pool spa app] (rev3-04).xls
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3. OWNER'S NAME LAST FIRST
Locre-
ADDREESS
OWNER'S E-MAIL ADDRESS
PLAN CHECK NO
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CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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064-41,'
ADDRESSENGINEER'S
E-MAIL ADDRESS
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CITY;; STATE ZIP
PHONE NO.
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5. CONTRACTOR'S NAME
BUSINESS LICENSE STATE LICENSE
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No. g3` s e eclass
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP IPHONE
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NO.
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DRAINAGE P/C FEE $
Forms\Pool spa app] (rev3-04).xls
(� 2&2-0
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OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa app] (rev3-04).xls
(� 2&2-0
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