HomeMy WebLinkAboutS2019-0184 - Permit ApplicationLcl' DWI
Q+ 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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LEGAL DESCRIPTION
LOT -21 BL/OCK / TRACT l SZZZ
2. DESCRIPTION OF WORK 1117 1
ESTIMATED $ VALUATION �5 , f�c�c>
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IV
SWIMMING POOL ❑ SPA POOL FENCING ❑ DRAINAGE L�
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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
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PHONE NO.
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n 4. ENGINEER'S NAME LAST FIRST LICENSE NO.
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ADDRESS`` ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
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rl 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
CE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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