HomeMy WebLinkAboutS2021-0275 - Permit Applicationf WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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 N�V✓ �iII ��L ANn �I A 2�, x 1
ESTIMATED $ VALUATION
SWIMMING POOL Ej/ SPA - \ POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
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ADDRESS
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OWNER'S E-MAIL ADDRESS
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CITY' SST/ATE ZIP
PHONE NO.
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4. ENGINEER'S NAME'(7,>vL AGTN E' T FIRST
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LICENSE NO.�
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
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PHONE NO.
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5. CONTRACTOR'S NAME /C
BUSINESS LICENSE
STATELICENSE
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ADDRE S
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CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
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PHONE NO.
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ONLY
f NO.
PLAN HECK NO.
J, POOL P/C FEE $
DRAINAGE P/C FEE $
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