HomeMy WebLinkAboutS2018-0052 - Permit Application061,
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH OC8840/8
52019.0052
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
H 1l Not51n ST�r�
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION 2S) )DQ
SWIMMING POOL ❑ SPA M--' POOL FENCING [I DRAINAGE
Check Anorooriate box for Anolicant
E] 3. OWNER'S NAME LAST FIRST
Tom SU I r
ADDRESSWNER'S
OE-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
N�3v.,Pn L C% 01 -z6 60
2(3-. LOq-OBL4 I
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
Poo I— G—WC-\) L e --�-G0kD
(, "1 f.,S(,
ADDRESS
ENGINEER'S E-MAIL ADDRESS
120 � -1,� � TU 5 i I�
CITY STATE ZIP
PHONE NO.
C)
❑ 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
CPE SIY��u PGO ( �} S j�S
-t
1 Z I
Nod 'S Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
�43 761.E �r�R ��.
Pa,V�Sa��y Ii ZZ.��M0.�L . COY.
CITY STATE ZIP
PHONE NO.
�jh-� P gob0�3
"71" 31�. ,3g1)
'E USE ONLY
PERMIT NO. S10to# OdSZ
PLAN CHECK NO. 0&?S S.SOI 8
POOL P/C FEE $
DRAINAGE P/C FEE $
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