HomeMy WebLinkAboutS2021-0122 - Permit Application,4 NP°8, WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
xas "- CITY OF NEWPORT BEACH S 207;0
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
Zo 0/-,0
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK l ��ti � �v G �y� F-�'.L S /PS Z ��
ESTIMATED $ VALUATION �� o
SWIMMING POOL SPA v
Check Appropriate box for Applicant
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME
LAST
FIRST
ADORES
OWNERS E-MAIL ADDRESS
CITY STATE
ZIP
PHONE NO.
4. -�
_ ' LAST
FIRST ,
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTORS NAME
BUSINESS LICENSE
STATE LICENSE
%% t/
y
No. class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Farms\Pool spa appl (rev3-04).xls