HomeMy WebLinkAboutS2018-0060 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
a CITY OF NEWPORT BEACH
BUILDING DIVISION
1. F'KUJLL; I AUUKEbb (NOT MAILING ADDRESS)
LEGAL DESCRIPTION /
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2. DESCRIPTION OF WORK Cv-71 J 7/'N-' 7L /,- F TTS /�o ° ! ci h a/` -5,'�/�
B ESTIMATED $ VALUATION SZ, o 0
SWIMMING POOL
Check Aoorooriate box for Aoolicant
POOL FENCING ❑ DRAINAGE ❑
❑ 3. OWNER'S NAME/ LAST FIRST
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ADDRESS
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OWNER'S E-MAIL ADDRESS /
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CITY STATE ZIP
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PHONE NO.
32
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
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CITY/�J� // STATE cZ�IP
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PHONE NO.
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5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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NJ4.7770 Class
ADDRESS
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CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
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PHONE NO.
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OFFICE USE ONLY
PERMIT NO. S �Q {(��l D o G O
PLAN CHECK NO. O " IAi11 Q (� \r\ J
POOL P/C FEE $ 0
Forms\Pool spa appl (rev3-04).xls