HomeMy WebLinkAboutX2021-3362 - Permit Application (3)WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH ,
BUILDING DIVISION �s�Z
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
3001 Grob 5�• �e Li, 6rRea(
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK POO' W I A lP6G�
SWIMMING POOL ❑ SPA ❑
%,necK Appropriate box for Applicant
_ ESTIMATED $ VALUATION
POOL FENCING ❑
DRAINAGE ❑
3. OWNER'S NAME
LAST
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
ADDRESS
BUSINESS LICENSE STATE LICENSE
No. Class
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
/ y
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