HomeMy WebLinkAboutS2020-0009 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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'"x �' CITY OF NEWPORT BEACH
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BUILDING DIVISION G2."o-o0i0°i
PLEASE PRINT OR TYPE
1.PROJECT
`ADDRESS (NOT MAILING ADDRESS) -.-- _.... .. _. _...
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK '3 Cry
ESTIMATED $ VALUATION .-
SWIMMING POOL SPA [✓ POOL FENCING 'j DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
Com . cs� AS
ADDRESSOWNER'S
E-MAIL ADDRESS
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{jCIT Y (i STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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No. Class
ADDRESS{�
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO. _
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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