HomeMy WebLinkAboutS2020-0152 - Permit ApplicationI ZC)
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE !
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK -kc- " !'� %n
ESTIMATED $VALUATION O�iC7
SWIMMING POOL ❑ SPA ❑ POOL FENCING ❑ DRAINAGE Eir
Check Aonropriate box for Applicant
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
0 4. E GINEER'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 I—
BUSINESS LICENSESTAT4E+
LICENSE
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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OFFICE USE ONLY
PERMIT NO. 570 Z-0 �� �L%S 'Z -
PLAN
PLAN CHECK NO. (14c"
POOL P/C FEE $
DRAINAGE P/C FEE $
Fortes\Pool spa appl (rev3-04).xis