HomeMy WebLinkAboutS2021-0267 - Permit Applicationa
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE L
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
\x
LEGA -DESCRIPTI N
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL SPA ❑
Check Appropriate box for Applicant
�E� . b �
_ ESTIMATED $ VALUATION
POOL FENCING ❑
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
IV
CITY STATE
PHONE NO.
CZIIP�
❑ 4. ENGINEEER''(S��N-AME LAST FIRST
LICENSE NO.
V W�
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
V
No. Class
ADDRESS
CONNTTRRA4C'TOR'S E-MAILA7DDRESS
t ` y
I
CITY STATE ZIP
PHONE NO.
CJS 1zto b
1 -1 H
OFF/CE USE ONLY _
PERMIT NO. �� ` O G ( —7
PLAN CHECK NO. Fj �� `✓ 1 C) 16
G s ul
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls