HomeMy WebLinkAboutS2014-0103 - Permit ApplicationWORKSHEET FOR POOLISPA PERMIT APPLICATION
�" CITY OF NEWPORT BEACH !�'� C �'l -^G (0
° BUILDING DIVISION
PLEASE PRINT
1. PROJECT ADDRESS ( T MAILING ADDRESS)
FLOOR
SUITE NO.
U � / �i?
STATE
ZI��
4. APPLICANT'S NAME LAST FIRST
LEGAL DESCRIPTION
No. UNITS
LOT BLOCK
TRACT
STITE
2. DESCRIPTION OF WORK
�— 7
� / ESTIMATED$ VALUATION cov,
SWIMMING POOL SPA PO^R PT : - --E)FHE-R-O-
3. OWNER'S NAME LAST FIRST
`'urs- t>
PHONE NO.
S A
OWNERZ3DDRE�SS ��®�0�
U_
CITY
NI-
STATE
ZI��
4. APPLICANT'S NAME LAST FIRST
Pl(HCI,IO_hN.E NO.
p
I �- 693 Vu
APPLICANT'S ADD3'ESS
CITY
STITE
ZfI�P/
y�
V A- � VAI--
OTHER MISC.
lJ'�.
?v
5. ARCHITECT/DESIGNER'S NAME LAST FIRST
STATE LIC. NO.
ARCHITECT/DESIGNER'S ADDRESS
CITY STATE ZIP
PHONE NO.
6. ENGINEER'S NAME LAST FIRST
441-1
STATE LIC. N0.
1Z� o
O
ENGINEER'S ADDRESS
CITY STATE ZIP
PHONE NO.
�2-0
IT,A
7', ro
7. CONT CTOR'S NAME
-vtc- povi,S
L C. CLASS STATE LIC. NO.
Ure-
CONTRACTOR' ADDRESS
//
CITYS(E
% q(ZIP JW
IRT
APPLICANT'S EMAIL ADDRESS
NEWPORT BUS. LIC. NO.
POOL/ SPA ITEMS
NO.
WATER SERVICE
GAS SERVICE
WATER HEATERS
P -TRAP
ANTI -SYPHON VALVE
ELECTRIC SYSTEM
OTHER MISC.
OFFICE USE ONLY
PERMIT NO. J
PLAN CHECK NO.
PLAN CHECK FEE $