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HomeMy WebLinkAboutS2018-0220 - Permit Application11 1 6 C, C©��e'A� WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION gg q o -.201:? Ep4RgpN,°: CITY OF NEWPORT BEACH SAWN -0.290 BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) 121 oto <ov1.r4I? % i w LOT BLOCK 2. DESCRIPTION OF WORK miil✓ .r �d N W I ( ESTIMATED $ VALUA SWIMMING POOL ❑ SPA Ly' POOL FENCING ❑ DRAINAGE ❑ ❑ 3. OWNER'S NAME LAST FIRST ,8.?Ehf.T T�� .,Fw px -V Jr4 c� ,c ADDRESS OWNER'S E-MAIL ADDRESS 1.21 O L9 covrrP PA CITY STATE ZIP �P,.,,�,�✓� pE'� cN Cid . gy 6 L o PHONE NO. (9519, 922s 269 4. ENGINEER'S NAME LAST FIRST ICENSE NO/.. tilD44 4Xc)w rYi /1T-rAec � r `" ADDRESS ENGINEER'S E-MAIL ADDRESS AvC CITY STATE ZIP PHONE NO. A-41-4h►Eo M� �f?. 79777 5. CONTRACTOR'S NAME BUSINESS LICENSE STATE LICENSE p .T<NWaf�2 / 66GS 96732 S" No. Class ADDRESS 8�✓� �/ j0 CONTRACTOR'S E-MAIL ADDRESS 7`v tri J'cgw�r��vo✓s. 'roAl .33v3 ,t/�r�mr . CITY STATE ZIP <W7 -A PHONE O. :E USE ONLY PERMIT NO. PLAN CHECK NO. POOL P/C FEE $ DRAINAGE P/C FEE $ Farms\Pool spa appl (rev3-04).xis