HomeMy WebLinkAboutS2015-0023 - Permit ApplicationWORKSHEET FOR POOLISPA PERMIT APPLICATION
�7 �'�� CITY OF NEWPORT BEACH
"L BUILDING DIVISION
PLEASE PKIN I
1. PROJECT ADDRESS (NOTMAILING ADDRESS)
FLOOR
SUITE NO.
LEGAL DESCRIPTION
No. UNITS
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Jvt�Cl ✓I d d,-� PLJl� L �"LE MA' > 19
CCU f'/ -� .
jjv KyoL LI VT . ESTIMATED$
VALUATION v
SWIMMING POOL SPA ❑ PORTABLE SPA ❑
OTHER ❑
3. OWNER'S NAME LAST FIRST
PHONE NO.
940 '3 �� — i�� r
b4 EPP.y Y r� I
OWNER'S ADDRESS
CITY
STATE ZIP
61266,0
2�K��
4. APPLICANT'S NAME LAST FIRST
PHONE NO.
j '
APPLICANT'S ADDRESS -
I3ti/w 5'- ���! j¢tLv�t %7Lv-/J
CITY
r �+`l
STATE ZIP
e-/ °3Z O
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
STATE LIC. NO.
ENGINEER'S AIJURESS!� /
CITY STATE ZIP PHONE NO.
e�"' ��Z ewl '7*,?t(l.'��10
7. CONTRACTOR'S NAME
�L� co�s��'�` n�cc�
LIC. CLASS
C 53
STATE LIC. NO.
1 f '3�23
�
CONTRACTOR'S ADDRESS
�. � laz �� r3� �e�
CITY STATE
d1 f1 F,,
ZIP PHONE NO.
92 5 r� �2�—
�•
APPLICANT'S E-MAIL ADDRESS
NEWPORT BUS. LIC. NO.
POOL / SPA ITEMS
NO.
'�✓ r
�� ��Ia
WATERSERVICE
1 .� p
J 31 1
GAS SERVICE
WATER HEATERS
P-TRAP
ANTI -SYPHON VALVE
ELECTRIC SYSTEM
OTHER MISC.
OFFICE USE ONLY
PERMIT NO.
V W d JJ ✓
PLAN CHECK NO.
PLAN CHECK FEE $
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