HomeMy WebLinkAboutS2017-0033 - Permit ApplicationC-ZN Fib
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE �111
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK /(/& h�
Q 2.. ESTIMATED $ VALUATION
SWIMMING POOL ❑ SPA, POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
1 OWNER'S NAME
o�? "
LAST
CCC
FIRST
n14
ADDRESS
OWNER'S E-MAIL ADDRESS
/Cf CITY
S TE
/ ZIP
PHONE NO.
' ' /
N/ t/ IN
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
CE USE ONLY p _
PERMIT NO. sCZ-0f
PLAN CHECK NO. (J �� Z
POOL P/C FEE $
DRAINAGE P/C FEE $
Farms\Pool spa appl (rev3-04).xls