HomeMy WebLinkAboutS2020-0105 - Permit Application��LiYUANit�
WORKSHEET 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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BLOCK
TRACT
F2.SCRIPTION OF WORK NeW POOL Pmv� 5p�+ Z x f� �' 4Z �(ry ISe y) 13�Nr� IT
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MING POOL [2' SPA �T' POOL FENCING ❑ DRAINAGE
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Fo 3. OWNER'S NAME
LAST
FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
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STATE
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ZIP
PHONE NO.
0 4. ENGINEER'S NAME
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LAST
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FIRST
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LICENSE N0.
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ADDRESS
E-MAIL ADDRESS
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CITY
STATE
ZIP
PHONE NO7-L
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E] 5. CONTRACTOR'S NAME
BUSINESS LICENSE
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ADDRESS
CONTRACTOR'S E-MAILADDRESS
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CITY
STATE
ZIP
PHONE N0.
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;E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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