HomeMy WebLinkAboutS2020-0039 - Permit Application91,020--COZI
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
,H 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
SWIMMING POOL SPA
Check Appropriate box for Applicant
_ ESTIMATED$ VALUATION 4o
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3. OWNER'S NAME LAST FIRST
/
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
(-/IrL 92-6zs
PHONE NO.
5`/F
4. ENGINE NAME LAST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
IPHONE NO.
5. CONTRACTOR'S NAME
BUSINESS ICENSE
STATE LICENSE
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No.7267�v Class
CONTRACTOR'S E-MAIL ADDRESS
�AJDDRESS J n _ ` / /
ITY STATE ZIP
PHONE NO.
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:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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