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+'w WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
p CITY OF NEWPORT BEACH
PLEASE PRINT OR TYPE BUILDING DIVISION
1. PROJECT ADDRESS NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT
BLOCK
2. DESCRIPTION OF WORK
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SWIMMING POOL
Check Appropriate box for
3. OWNER'S NAME
ADDRESS
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4. ENGINFFR'.c mARAc
5. CONTRACTOR'S NAME
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ADDRESS
27 7 (0 7-
'/CE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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ESTIMATED $ VALUATION le, 0 0 0
POOL FENCING ❑ DRAINAGE ❑
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CONTRACTOR'S E-MAIL ADDRESS
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ZIP PHONE NO.
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