HomeMy WebLinkAboutS2021-0288 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION n
CITY OF NEWPORT BEACH com n L I
BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
-�5M 571`e4l-r-4_ 1�s
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK i w
SWIMMING POO SPA
Check Appropriate box for Applicant
ESTIMATED $ VALUATION S�
POOL FENCING- DRAINAGE ❑
❑ 3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNERS E-MAIL ADDRESS
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CITY STATE ZIP
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PHONE NO.
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS ENGINEER'S E-MAIL ADDRE S
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
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BUSINESS LICENSE
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STATE LICENSE C - Z
No/0Y37v3CIas8
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITYSTATE ZIP
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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
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