HomeMy WebLinkAboutS2017-0189 - Permit Application0��4"" WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
"" BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
2 ZZ U y\ 1`
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK U� n vK0
ESTIMATED $ VALUATION I rD J
SWIMMING POOL �2� SPA PO PROINAAE Q—
k A - to box for A licant
Chec pproprla pp
3. OWNER'S NAME LAST FIRST
ADDRESS
WNER'S E-MAIL ADDRESS
r
ZZ21 `-J Uv\vl/-Q—
CITY
1,) - `6.
STATE ZIP
5ez
PHONE NO.
qq9- 87(- 03D5
4. ENGINEER/'S NAME
LAST FIRST
LICENSE NO.
GRCAZ✓
70 L>
6-76S-(.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
t 7.0l t..1 - 1 S -I It)
CITY
STATE ZIP
PHONE N0.
%/7630610-0
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE C/
3
151/1 F, 64jTVf^ 1?000f
No Z S8�` class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
Z s87
CITY
LAIDE (=vgEs r
STATE ZIP
�z� 30
PHONE NO.
CIO B� g l (/zzb
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls