HomeMy WebLinkAboutS2022-0254 - Permit Application�yyyriH
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
SWIMMING POOL`❑ SPA]
Check Anpronriia\te box for Annlicant
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ESTIMATED $ VALUATION
POOL FENCING ❑
DRAINAGE ❑
3. OWNER'SNAME LAST FIRST
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ADDRESS
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OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
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PHONE NO.
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ENGINEER'S NAME LAST FIRST
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LICENSE NO.
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ADDRESS �
ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
P}IONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE 5
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
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PHONE NO.
: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