HomeMy WebLinkAboutS2021-0055 - Permit Applicationa
OR TYPE
DESCRIPTION
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
(NOT MAILING ADDRESS)
BLOCK TRACT
2. DESCRIPTION OF WORK N('y\)
ESTIMATED $ VALUATION ZSI O LT -D
SWIMMING POOL ❑ SPA POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3.
OWNER'S NAME
LAST
FIRST
C, o 18 Vic r
ADDRESS u
OWNER'S E-MAIL ADDRESS
Y
CITY
STATE
ZIP
PHONE NO.
4.
E INEER'S NAME
LAST
FIRST
LICENSE NO.
P O
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5.
CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
No. rOBZlkQ(Dmass
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
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C(-)
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USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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