HomeMy WebLinkAboutS2021-0015 - Permit ApplicationS7AZ1•aoi5
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING A�DDDRESS n
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LEGAL DESCRIPTION
LOT � ej BLOCK TRACT A-23
2. DESCRIPTION OF WORK
SWIMMING POOL
ESTIMATED $ VALUATION
SPA L_4 POOL FENCING ❑ DRAINAGE
Check Appropriate box for Aoolicant
3. OWNER'S NAME
1
LAST
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ADDRESS
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OWNER'S E-MAIL ADDRESS
CITY STATE
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ZIP
PHONE N0.
7 1 Cl 0./
4. ENGIN ER'S NAME
LAST
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,FIRST
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ADDRESS^
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ENGINEER'S E-MAIL ADDRESS
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5. CJOON'TRACTOR'S
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BUSINESS LICENSE
STATE LICENSE
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ADDRESS
ADDRESS
11-73/
CONTRACTOR'S E-MAIL ADDRESS
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CITY
STATE
ZIP
PHONE NO.
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OFFICE USE ONLY
PERMIT NO.
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PLAN CHECK NO.
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S/
POOL P/C FEE $
DRAINAGE P/C FEE $
For MPool spa appl (rev3-04).xls
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