HomeMy WebLinkAboutS2021-0125 - Permit ApplicationQ�
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH M,^ti'l��1�`j
BUILDING DIVISION �j �U !/✓
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION / C
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Ak
ESTIMATED $ VALUATION
SWIMMING POOL ■ SPA61 POOL FENCING■ DRAINAGE 11
Check Appropriate box for Applicant
3. OWNER'SNAME LAST FIRST
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ADDRESSOWNER'S
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E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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4. ENGINUIER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
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CITY STATEZIP
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PHONE NO.
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5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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No. CI
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
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;E USE ONLY
PERMIT NO.
PLAN CHECK NO. Z-0
POOL P/C FEE $ I V
DRAINAGE P/C FEE $
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