HomeMy WebLinkAboutS2019-0027 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
ro n CITY OF NEWPORT BEACH
BUILDING DIVISION
PI FARE PRINT OR TYPF
1 PROJECT ADDRESS (NOT MAILI ADD&ESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL ❑ SPAX
f[hark Annrnnrinfa hnY fnr Anniirnnt
ESTIMATED $ VALUATION
POOL FENCING ❑ DRAINAGE ❑
n 3. OWNER'S NAME LAST FIRST
S:-1 6A vl (.rO n
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
�cd? FN LO Yv
CITY STATE ZIP
PHONE NO.
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C,
5. CO5NTRAC R'S
BUSINESS LICENSE
STATE LICENSE g.
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7
No. J?�O (�7rtaSC
ADDRESS
CONTRACTOR'S E -M IL ADDRESS
J(_
CI�cb k STATE 7 ZIP
67
PHONE (-, -
W
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $ \
Forms\Pool spa appl (rev3-04).xls 4
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