HomeMy WebLinkAboutS2018-0085 - Permit Application.2673
LOT
`�-) �-O 1,-6 - O04i5:j
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
J BUILDING DIVISION
(NOT MAILING ADDRESS)
2. DESCRIPTION OF WORK 0 fA-10JVC*1
pp510ESTIMATED
SWIMMING POOL L/ SPA ❑ POOL FENCING
Check Appropriate box for Applicant
TRACT
$ VALUATIO 3U,yD
❑ DRAINAGE
3. OWNER'S NAME LAST FIRST
d.A A/ �
e� r
ADDRESS
2,67' a� SSWb pp S'T�-P e r -
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
1✓Pwfov✓4 grj4C-H C -A.
PHONE NO.
rl 4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
.%-CAJWA/J! /4ULS
7(o 73 25-
Noo.. Class
ADDRESS
00
CONTRACTOR'S E-MAIL ADDRESS
6ep(@ do4wit!'i/Voo).rco
CITY STATE ZIP
jPrONE 0.
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
v
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls