HomeMy WebLinkAboutS2017-0173 - Permit ApplicationF NEWPORT . ' - WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CI BUILDING DIVISION CH Wortwort$
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LOT
2. DESCRIPTION OF WORK
BLOCK
TRACT
SWIMMING POOL ❑ SPA 0 POOL FENCING ❑ DRAINAGE ❑
Check Aoorooriate box for Aoolicant
3. OWNER'S NAME LAST FIRST
ADDRESS
a rerq
J
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
ZL 7X
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
4'Gl�k 00 t7
PHONE NO.
j7W,9 3O /fid
5. CONTRACTOR'S NAME
GN�jFi�/c��
BUSINESS LICENSE
STATELICENSE
Class
ADDRESS
ealle 1�� ��
CONTRACTOR'S E-MAIL ADDRESS
deagsea/ ,s?00/s6p�ik,nc',�,
CITY STATE ZIP
cf��L &Izl��e1,f74!— C'4—
PHONE NO. /
W USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls