HomeMy WebLinkAboutS2021-0230 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
' a CITY OF NEWPORT BEACH
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BUILDING DIVISION 9ZM -0230
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
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SWIMMING POOL gl SPA Lys
Check Aoorooriate box for Aoolicant
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_ ESTIMATED $ VALUATION
POOL FENCING in� DRAINAGE [�
3. OWNER'S NAME
LAST
FIRST
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ADDRESS%
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
NP5
CA+-
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to
4. ENGINEER'S NAME
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LAST
S
rFIRST
LICENSE NO.
-416
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✓l
p�C✓
ADDRESS
ENGINEER'S E-MAIL ADDRESS
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CITY
STATE
ZIP
PHONE NO.
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5. CONTRACTOR'S NAME
BjUUSSIIN�E�S`S' LICENSE
STATEgLIC1�EfNSE
77
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No. i�0 !%-I Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
P3
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qZ(b 3
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa app] (rev3-04).xis
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