HomeMy WebLinkAboutXR2023-1264 - Permit Application*. 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 �� Y" b
ESTIMATED $ VALUATION
SWIMMING POOL' SPA-4 POOL FENCING ❑ DRAINAGE ❑
b f A licant
Check Approprme ox or pp
LAST FIRST
3. OWNER'S NAME
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
Q
BUSINESS LICENSE
STATE LICENSE
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
'E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
- i ZI 6 V
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).XIS
-7 53