HomeMy WebLinkAboutS2022-0224 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL jq SPA]
Check Appropriate box for Applicant
ESTIMATED $ VALUATION S�) . DU
POOL FENCING ❑ DRAINAGE ❑
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OWNER'SNAME
FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY
STATE
ZIP
PHONE NO.
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4.
EN INEER'S NAME
LAST
FIRST
LICENSE NO.
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ADDRESS
rENGINEER'S
E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5.
CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CIITY
STATE
ZIP
PHONE NO.
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:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
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DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls