HomeMy WebLinkAboutX2022-0523 - Permit Applicationq'W►�qr WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF N WP
E ORT BEACH
PLEAS PRINT OR TYPE BUILDING DIVISION XJ/_a-
F. PROJECT ADDRESS (NOT MAILING ADDRESS)
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2• DESCRIPTION OF WORM_- A$7-V f- r OJ 3 �o,6 t3�- � Cj(%'
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SWIMMING PO0QT SPA POOL FENCING ❑ DRAINAGE5 Cl
Check Aoorooriate box for Anntirant
3. OWNER'S NAME to T
FIRM
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IL
ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE
ZIP PHONE NO.
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4. ENGINE NAME LAST
FIRST
LICENSE NO.
!lEADDRESS
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ENGINEER'S E-MAIL ADDRESS
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CITY STATE
ZIP
PHONE NO. r
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5. CONTRACTOR'S NAME
BUSINESS LICENSE LICENSE
ESTATE
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O R CTOR' -MAIL AD RESS�
CITY STATE
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ZIP PHONE NO.
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CPERMI T� NO.jZ0a ?'r
PLAN .CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Formsftol spa appi (rev3_ 4).xis
4-114
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