HomeMy WebLinkAboutS2021-0239 - Permit Applications2o21-02Sq
°q"" P°� WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION AeVZZ -O 1+w
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lau.d.� `,. CITY OF NEWPORT BEACH
BUILDING DIVISION
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1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK � Ig 1
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SWIMMING POOL SPA ❑
ChPrek Annrnnriate box for Anniicant
_ ESTIMATED $ VALUATION
POOL FENCING ❑ DRAINAGE ❑
Ei 3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
265
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. ONTRACTOR'S NAME //^!�/ A 1
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BUSINESS LICENSE
STATE LICENSE
No. { Class
ADDRES
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CONTRACTOR'S E-MAIL ADDRESS
57aw-p
STATEq� ZIP
PHONE NO.
: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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