HomeMy WebLinkAboutS2020-0091 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)-- - _.... _... _... ..
LEGAL DESCRIPTION yy
LOT BLOCK TRACT -LIQ
2. DESCRIPTION OF WORK IV2.
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SWIMMING POOL ❑ SPA (�
Check Annronriate box for Annlicant
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ESTIMATED $ V
POOL FENCING ❑
5�0 C
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
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.. ADDRESS
OWNER'S E-MAIL ADDR ESS
Jr7 - /
CITY STATE ZIP
PHONE N^O�.LL��
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4. ENGINEER'S NAME— LAST RST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
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CITY / STATE ZIP
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PHONE NO.
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F1 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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No. Class
ADDRESS J/
CONTRACTOR'S E-MAIL ADDRESS
CIT STATE ZIP
PHONE N0,
OFFICE USE ONLY
PERMIT NO. 71 VA W
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $ l-5
Forms\Pool spa appl (rev3-04).xls X-41
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