HomeMy WebLinkAboutS2016-0089 - Permit ApplicationWORKSHEET FOR POOLISPA PERMIT APPLICATION
mCITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT
134 ` 2016
s.2016- 00 gq
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
PHONE NO.
LOORSU
ITE NO.
24
STA/T�Ep
ZIIyP
LEGAL DESCRIPTION
P -TRAP
No. UNITS
LOT BLOCK TRACT
4. APPLICANT' NAME L ST FIRST
bEwt= vi
ELECTRIC SYSTEM
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATIONS
SWIMMING POOL SPA ❑ PORTABLE SPA ❑ OTHER ❑
3. OWNER'S NAME LAST FIRST
PHONE NO.
6r wn9A cv,-
vjiq-3`3- qq
OWNER' ADDRESS
CITY
STA/T�Ep
ZIIyP
P -TRAP
Izc�t�.i
4. APPLICANT' NAME L ST FIRST
bEwt= vi
ELECTRIC SYSTEM
PHONE NO.
LIIQ-5u� "3355'
APPLICANT'S ADDRESSQTY
ISC�G 6� N,L t
lis a�1�S�
STATE
IZIP
�ZI�Z�
5. ARCHITECT/DESIGNER'S NAME LAST FIRST
STATE LIC. NO.
Q L4 teb
ARCHITECT/DESIGNER'S ADDRESS
CITY STATE ZIP
PHONE NO.
6. ENGINEER'S NAME LAST FIRST
STATE LIC. No.
`
ENGINEER'S ADDRESS
CITY STATE ZIP
PHONE NO.
7. CONTRACTOR'SNAME
lv\VL1L� —
LIC. CLASS
F�if'3 C-Z-t--5�
STATE LIC. NO
14�j
CONTRACTOR'S ADDRESS
CITY STATE ZIP
PHONE NO.
APPLICANT'S E-MAILADDRESS
G— uuyi ccs-
NEWPORT BUS. LIC. NO
3o��aa
POOL/SPAITEMS
NO.
WATER SERVICE
1
GAS SERVICE
WATER HEATERS
P -TRAP
ANTI -SYPHON VALVE
ELECTRIC SYSTEM
I
OTHER MISC.
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEE