HomeMy WebLinkAboutS2017-0202 - Permit ApplicationWORKSHEET FOR POOLISPA PERMIT APPLICATION
S t1V I ®" "� d£ CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT L7 /�
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
FLOOR
SUITE NO.
(� e kl1 o nom_
OWN 'S ADDRESS
CITY
LEGAL DESCRIPTION
NoUNITS
LOT BLOCK TRACT
toowpr
2. DESCRIPTION OF WORK G/
ESTIMATED $ VALUATION's
SWIMMING POOL SPA PORTABLE SPA ❑ OTHER ❑
3. OWNER'S NAME LAST FIRST
PHONE NO.
44
, Z3 0ct Q2
OWN 'S ADDRESS
CITY
STATE
ZIP
&, Imo, �( e-
toowpr
ANTI -SYPHON VALVE
4. APPLICANT'S NAME LAST FIRST
PHON NO.
,
OTHER MISC.
APPLICANT'S ADDRESS
CITY
STATE
ZIP
3t _k t*<a�rt
5. ARCHITECT/DESIGNER'S NAME LAST FIRST
STATE LIC. NO.
`� AM
ARR'SA
CHITECT/DESIGNEDDRESS
CITY STATE ZIP
PHONE NO.
6. ENGINEER'S NAME LAST FIRST
STATE LIC. NO.
C� -P
q7 t
ENGINEER'S ADDRES
CITY STATE ZIP
PHONE NO.
0 , � 1
1 T, If A,
� .,i z
. CONTRALTO SMAM
LIc. CLASS STATE LIC. NO.
CONTRACTOR'S ADDRESS CITY STATE ZIP PHONE NO.
12 12 2- A(-I.t25¢. (!�A `267 `u 2yz
_srE/� p'�G
A�PLIOANT'S E-MAIL ADDRESS (- NEWPORT BUs. LIC. NO.
_ _ `
POOL/SPA ITEMS
NO.
WATER SERVICE
GAS SERVICE
WATER HEATERS
P -TRAP
ANTI -SYPHON VALVE
ELECTRIC SYSTEM
OTHER MISC.
OFFICE USE ONLY
PERMIT NO. Su> 17 -
PLAN CHECK NO. I,()- - 7ZO I -I
PLAN CHECK FEE $ v
2