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HomeMy WebLinkAboutS2018-0167 - Permit Application (2)WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION a CITY OF NEWPORT BEACH /� PLEASE PRINT OR TYPE BUILDING DIVISION S ZV `> ( f/ 1' PFS ECT ADDRESS (NOT MAILING ADDRESS) BLOCK 2. DESCRIPTION OF TRACT ESTIMATED $ VALUATION ��, 0O© SWIMMING POOL � SPA —�— POOL FENCING ❑ DRAINAGE Check Appropriate box for Applicant ] 3. OWNER'S NAME ST FIRST ADDRESS �J OWNER'S E-MAIL ADDRESS CITY (�J �C�1�C� 1✓ yA iU 1:Q �lcc e=cy�•t M&A _ STATE / ZIP !PHONE NO. 14. ENGI ER'S NAME (p2( Z3Z —<131 P60\ 17 --LAST FIRST � �jj � l LICENSE NO. ADDRESS TIJ G 2O` P. �` ,�' l \ ENGINEER'S E-MAIL gDDR SS CITY 1 ! ' STATE ZIP PHONE NO. 5. CONTRACTOR'S NAME 1 Z<zWd < 7 S� goBUSINESS LICENSE STATE LICENSE r� P,rS ADDRESS No F% 72C CONTRA T R'SSjE-MA//L ADDRESS Class �CG�T � STATE ZIP PHONE NO. /-� ��g7� Ic q7 CE USE ONLY PERMIT NO. PLAN CHECK NO. POOL P/C FEE $ DRAINAGE P/C FEE $ Forms1P001 spa app! (rev3-04).xls