HomeMy WebLinkAboutS2021-0264 - Permit Application"7 °R> WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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"` CITY OF NEWPORT BEACH
'IGII(14N�*
BUILDING DIVISION {� 1'
PLEASE PRINT OR TYPE S101-1 • WIN
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LOT
BLOCK
TRACT
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION I�� (rC L'1
SWIMMING POOL �Z SPA ( POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
ADDRESS
O NER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
(—
BUSINESS LICENSE
STATE LICENSE
No. - 3 / 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 $
Forms\Pool spa appl (rev3-04).xis