HomeMy WebLinkAboutS2018-0111 - Permit ApplicationE-`"° ° WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION 1 q 7
r .or. CITY OF NEWPORT BEACH �t.
BUILDING DIVISION
PLEASE PRINT OR TYPE 4�-4tt``Q-
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK ooL v'r
ESTIMATED $VALUATION U CLOD
SWIMMING POOL,,V SPA POOL FENCI D14R1td€c6C�_
Check Annronriate box for Anolicant
❑ 3. OWNER'S NAME LAST FIRST
ADDRESS))
L i �i���
OWNER'S E-MAIL ADDRESS
D (o WAS
CITY STATE ZIP
f4f'a Po" 4 �ZG 63
PHONE NO.
W7 v 6
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
�o76, -6
�
ADDRESS
20 d. --I
ENGINEER'S E-MAIL ADDRESS
I t tir
CITY ,� STATE ZIP
C� �2-FO
PHONE NO.
Cfobloz)
�7L�/^l ���/�
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE
� LICENSE C
i
�(
VA —,�s
0/y
Nod Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
/fir �G � !77
PHONE NO.
qi Z /off
Inc.
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls