HomeMy WebLinkAboutS2018-0121 - Permit Applicatione
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PLEASE PRINT OR TYI
LOT /3
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
(NOT MAILING ADDRESS)
BLOCK
TRACT
16 lig - 2019
60
2. DESCRIPTION OF WORK Y --w .SPA 1' gwwi-mewr,
ESTIMATED $ VALUATION oo
SWIMMING POOL ❑ / SPA
POOL FENCING ❑
3. OWNER'S NAME LAST
FIRST
ADDRESS
OWNER'S -MAILADDRESS
N
k /~ i,(5)pn rA Almitorh
CITY
PHONE NO.
/ST/
�ZII'P/
' I/
i�ATE
y q- 5 7-139
V Orr
_
l..//
I VU/
4.
ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGI ER'S E-MAIL ADDRESS
0-01 iv 1
,✓S> I� >,�
CITY
STATE
PHONE NO.
11
�tV�Iti�EIYh
(ZIP
V
L' b oo
5.
CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
CS3 Ld•'
1
r-
5-1 lob
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
S-0114nwv\ G It ws /Iansw hl awls.corp
CITY
STATE
ZIP
PHONE NO.
>r
LA
-714 -y97-8 39
;E USE ONLY ps 1 �j�
PERMIT NO. 1 W)I 6 O 6 1.
PLAN CHECK NO.
POOL P/C FEE $
Oka DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls