HomeMy WebLinkAboutS2018-0202 - Permit Application�Z�I�-oZoz
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
TRACT
2. DESCRIPTION OF WORK 121—e(v4�C( I rF'h�k I re�(11L "I �J) {1zw (L`i� f�
A cW q 4J I ✓uA(",) Ci I n t ESTIMATED $ VALUATION C 2? my U
SWIMMING POOL] SPA [( eL�J `POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
Ac( I(l el -,f
ADDRESS
G
At
OWNER'S E-MAIL ADDRESS
0
CITY !1 STATE ZIP
f Lc C 9'z (b
PHONE NO.
j e u 7 2-
4.
4. ENGINEE 'S NAME A
p
T `` FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR' NAME
s
BUSINESS LICENSE
STATE LICE SE
-777 0
�as
No. `�� Class
ADDRESS p LCONTRACTOR'S
�c 13
E-MAIL ADDRESS /
,j 4-14"
/ 3 � / < o) Vl � rf / s-
m -s 0 0 /. r e � 9�
CITY
G1�1 ik
STATE ZIP
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PHONE NO.
7� v—,Kz u -J—Y2_3
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls