HomeMy WebLinkAboutS2020-0075 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
�O Aa P
V K CITY OF NEWPORT BEACH
" BUILDING DIVISION
rLCMJC rMINI UK ITrC
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
C`Vc^/�C1u 1 'o
LEGAL DESCRIPTION
2. DESCRIPTION OF WORK
SWIMMING POOL [n SPA ❑
Check Appropriate box for Applicant
TRACT
_ ESTIMATED $ VALUA
POOL FENCING ❑
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
1
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
t
PHONE NO.
4. ENGINEER'S NAME ��`, LAST FIRST
LI ENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
0 5. CON/TRACTOR'S NAME
�!-SY�Ir ��.C`-)���} 1 UL V ci!j wi C,
BUSINESS LICENSE
STATE pLICE2NSE
No. Cs)�S �- Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
c= FC
CITY {� SETA/TE )ZIP IPHONEgENO.
�� Z�
i�� Vi -
:E USE ONLY
PERMIT NO.�
PLAN CHECK NO. �•�
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls