HomeMy WebLinkAboutX2019-3324 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACHKZoIcI -.90
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
14 e i CDL GL,-k—e a
LEGAL DESCRIPTION ::1
LOT BLOCK TRACT
2. DESCRIPTION OF
SWIMMING POOL ❑ SPA
Check Appropriate box for Applicant
_ ES61'iMATED $ VALUATIONS
POOL FENCING ❑ DRAINAGE F-1
3.
OWNER'S NAME
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LAST
7/10/-� ok L c
FIRST
C
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
STATE
q ZIP
PHONE NO.
4.
ENGINEER'S NAME
LAST
FIRST I
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5.
CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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 $
Forms\Pool spa appl (rev3-04).xls