HomeMy WebLinkAboutS2012-0112 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
BUILDING DEPARTMENT 9-d
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 ❑
ESTIMATED $ VALUATION
SPA K, POOL FENCING ❑
Check Anr)roDriate box for Annlicant
DRAINAGE ❑
® 3. OWNER'S NAME LAST FIRST
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ADDRESS
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OWNER'S E-MAIL ADDRE
CITY STATE ZIP
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PHONE NO.
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® 4. ENGINEER'S LAST FIRST
LICENSE NO.
'NAME
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ADDRESS
rENINEER'S E-MAIL ADDRESS
CITY STATE ZIP
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PHONE NO.
® 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE�S�
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY���� 11 n STATE ZIP
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PHONE NO.
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OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
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DRAINAGE P/C FEE $
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