HomeMy WebLinkAboutS2017-0090 - Permit ApplicationWORKSHEET FOR POOLISPA PERMIT APPLICATION
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EACH
BUILDING DIVISION �' \ l� ►\ lV
PLEASE PRINT A\7 G
LOT
2. DI
ESTIMATED $ VALUATION : A -j Uk A A
G POOL SPA PORTABLE SPA ❑ OTHER ❑
3. O 'S NAME LAST FIRST PHONE NO.
OWNER'SADDRESS CITY STATE ZIP
4. APPLICANT'S NAME FIRST PHONE NO.
APPLICANT'S ADDRESS CITY I STATEZIP
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5. ARCHITECT/DESIGNER'S NAME LAST FIRST I STATE LIC. NO.
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ENGINEER'S ADDRESS CITY STATE ZIP PgNEND.
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7. CONTRACTOR'S NAME LIC. CLASS STATE LIC. NO.
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CONTRACTOR'S ADDRESS CITY STATE ZIP PHONE NO. `'
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AP LICK ANT'SE-MAIL ADDRESS Q `n r5 i c �• , Cv NEWPORT BUS. LIC. NO.Lalf
POOL I SPA ITEMS
NO.
V
WATER SERVICE
GAS SERVICE
WATER HEATERS
P -TRAP
ANTI -SYPHON VALVE
ELECTRIC SYSTEMoil
OTHER MISC.
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEE
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