HomeMy WebLinkAboutS2017-0189 - Permit Application (2)WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
` CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
C- ZZ O v
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK UO vKo
SPA ESTIMATED $ VALUATION
SWIMMING POOL SPA PO �—
Ch 1,A ro riate box for Applicant
ec pp p
3. OWNER'S NAME LAST FIRST
5A c U y `T I -A,
ADDRESS
WNER'S E-MAIL ADDRESS
r
-7-2 Z 1 �Oh/-e-
CITYSTATE ZIP
PHONE NO.
,,�) - a. qez
qqq. 87c�-63-01
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
`acA2✓ 7o
6-76x6
ADDRESS
ENGINEER'S E-MAIL ADDRESS
(7.O1 rJ-'f�Sirr)
CITY STATE ZIP PHONE NO.
X12 U 714,706�o�
Amc IV,_ d
0-5--C ONTRACTOR'S NAME BUSINESS LICENSE STATE LICENSE
��LIiE 64j7vA ?oucf No Z 58� class�3
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
Z S87 ( vicn'?U
CITY STATE ZIP
L,ule ?=;Z i r §'zb 3o
PHON707
9(/9 /y2b
!E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa app[ (rev3-04).x15