HomeMy WebLinkAboutS2021-0126 - Permit Applicationn> CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LOT
BLOCK
TRACT
3. OWNER'S NAME LAST FIRST
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ADDRESS
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OWNERS E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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86
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ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIPPHONE
NO.
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5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
C S3
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No867776 Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
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-y2-8-J-f73
:E USE ONLY
PERMIT NO.
PLAN CHECK NO. u � �
IN
POOL P/C FEE $i
DRAINAGE P/C FEE $
Forms\Pool spa apps (rev3-04).xls