HomeMy WebLinkAboutS2018-0155 - Permit Applicationo+"° ° WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
°_ CITY OF NEWPORT BEACH
'�`"°`�� BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
10 s- roeT 1jS14Lt-vP�-
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK S f4-
G$s ESTIMATED$ VALUATION 2Yac�o
(�Crg
p Spq�=ooL,=EN61N�� DRAINAGE
Check Appropriate box for Applicant
ri 3. OWNER'S NA�ME LAST FIRST
(�tDo rM E
ADDRESS
OWNER'S E-MAIL ADDRESS
I ^
CITY STATE ZIP
PHONE NO.
QJ�?o- -�I-C4 �j.��6S-
152,$v7 /36-0
4. ENGINEER'S NAME LAST FIRST
�o� soy HAS
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP PHONE NO.
A4a j2�7
, ti,
5. CONTRACTOR'S NAME n /n BUSINESS LICENSE STATE LICENSE
2 � % 511(e-elleNo. /239�A Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
#��/
ITY STATE ZIP
Ola4q e CG LSO
PHONE NO.
171V V f 6 /'/z7 -]
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls