HomeMy WebLinkAboutS2018-0222 - Permit Application,2q iN-els
a WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
�`;,ow• CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
01,07 3>a_
I LOT BLOCK TRACT I
2. DESCRIPTION OF WORK C® 1 S l>/I-
/ �c i� ESTIMATED $ VALUATION
SWIMMING POOL L� SPA [g-' PQQI FraNGING- 0 SII GE
Check Appropriate box for Applicant
❑ 3. OWNER'S NAME LAST FIRST f
ADDRESSOWNER'S
E-MAIL ADDRESS
hoc
CITY / ,�/� STATE �r ZIP
.:kl � ° " \ C� (�(0 ��
PHONE NO.
l 9 9Y -71ST
4. ENGINEER'S NAME LAST FIRST
o o is
LICENSE NO.
6 746 4 -Ka
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY& ll eA� �TE " [ Vj
o
5. CONTR�CTOI 'S NAME
'?0OLS
BUSINESS LICENSE
STATE LICENSECS3
No. �) Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
+S (1 t�-L-Z-�U75lz�
CITY/'ly y,�1_ TATE ZIP
P'" L� G�J �
PH,OfNE NO.
cl4q'( 4SSj (S b (o
LO
.E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Fortes\Pool spa appl (rev3-04).xls