HomeMy WebLinkAboutS2018-0216 - Permit ApplicationLOT
S x,04 - 6210
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATIOK
CITY OF NEWPORT BEACH
BUILDING DIVISION
(NOT MAILING ADDRESS)
2. DESCRIPTION OF WORK
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TRACT
ESTIMATED $ VALUATION S cpo -
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE ❑ II
Check Aoorooriate box for Anolicant
3. OWNER'S NAME
LAST
FIRST
ADDRESS
NER'S E-MAILADDRESS
206
a
CITY
STATE
ZIP
PHONE NO.
C/Z
- 33
4. ENGINEER'S NAME
LAST
FIRST
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LICENSE NO.
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ADDRESS
ENGINEER'S -MAIL ADDR S
I
CITY
STATE
ZIPr7
PHONE NO.
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lei
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5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
C.
Z41
G53
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Na.Class�u
ADDRESS
CONTRACTOR'S E-MAIL
ADDRES
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CITY
STATE
ZIP
PHONE NO.
Quo-
114,
7 2706
7/I' ;3(73-6 356
Z USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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Forms\Pool spa appl (rev3-04).xls