HomeMy WebLinkAboutS2021-0133 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH Sai)a-t - 0133
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTTON
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
/ ESTIMATED $ VALUATION '/ J
SWIMMING POOL SPAt -,yo f'(Z'POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. O ER'S NAME, LAST FIRST
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ADDRESS 17
OWNER'SE-MAILADDR
CITY STATE ZIP
Xl—
PHONE NO.
❑ 4. EN 40rzf`RR''S N ME LAST/ FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
4/�"
L" L
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
OFFICE USE ONLY
PERMIT NO. �c"
PLAN CHECK NO. 1 911v 'IV i4
POOL P/C FEE $
DRAINAGE P/C FEE $
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Forms\Pool spa appl (rev3-04).xls