HomeMy WebLinkAboutS2021-0080 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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fey CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK 9�Q O 1
SWIMMING POOL SPA
Check Appropriate box for Aoolicant
4 41a �
_ ESTIMATED $ VALUATION 5D k
POOL FENCING ❑ DRAINAGE 171
3.
OWNER'S NAME
LAST
FIRST
ADDRESS(-
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
4.
ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
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5.
CONTRACTOR N('XM,
BUSINESS LICENSE
STATE LICENSE
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
:E USE ONLY
PERMIT NO. �20'L I e— 00$O
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $ �13g®rJ�
Forms\Pool spa appl (rev3-04).xls�