HomeMy WebLinkAboutS2017-0130 - Permit ApplicationTYPE
LOT
SZO I`1 0 m 3 0
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
(NOT MAILING ADDRESS)
BLOCK
TRACT
2. DESCRIPTION OF WORK
i
ESTIMATED $ VALUATION "9 otrcD
SWIMMING POOL El - SPA eCING ❑ DRAINAGE F]
Cheek Annrnnriatp hnv fnr Annlicant
❑ 3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
011A �RA-)
CITY STATE ZIP
PHONE NO.
7,y ctz-oz/o i
❑ 4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS 27 Icl
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
y
No.:?;,57%S3 Class 3
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
?h-AbT
ce
STATE ZIP
PHONE NO.
�1CITY
1 X695
1 7 i !0J--7322
f.>`J
:E USE ONLY
PERMIT NO. S Zo 1� •Q13D
PLAN CHECK NO.
POOL P/C FEE $j�:3L02�
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls