HomeMy WebLinkAboutS2018-0133 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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
2. DESCRIPTION OF WORK f5A fh-L.Cv---a Eir-i'l)
,QQ ESTIMATED $ VALUATION
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SWIMMING POO
Ia< SPA ❑ POOL FENCING ❑ DRAINAGE ❑
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3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. C/ OON�TRAGTOR'S NAME\^
BUSINESS LICENSE
STATE LI9ENSE
/
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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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