HomeMy WebLinkAboutS2017-0069 - Permit Applicationi -COC;,g
s4 "° +.� WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
n
eTp= CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
1633 Q jzw-�e- `Torr
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK ]ULW r ' eH a 5 (3,-)4 5W 14 o%^
-" %61u0 P440 �: wi Z ESTIMATED $ VALUATION A= �o
SWIMMING POOL M" SPA L7 POOL FENCING ff�' DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
S'P�v�nrrp'l,f �CVo,� Mav
ADDRESS
OWNER'S E-MAIL ADDRESS
ti vs. sz.-%a S'1L
CITY STATE P3
PHONE NO.
R`lct "4- TycG O
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
DRAINAGE P/C FEE $
ADDRESS
ENGINEER'S E-MAIL ADDRESS
iZC-t 0 TLA Ca .V.
CITY STATE ZIPPHONE
NO.
/.hnAlLtw� CA— Gz-�j -
--�4630-61
5. CONTRACTOR'S
BUSINESS LICENSE
STATE LICENSE
,NNAAME
-✓�S—C VST \O(�SC✓ [S30053
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No10TIb'Ai ciass5-3
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
`[S�12 CF>C> V\cL,,.K -Z L(-3
°SC�tv�C a ma1I,G
CITY STATE ZIP
r
PHONE NO. O6n
' LSAA cd�-- gz6 s e'
�tqQ,
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK N0.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls � % s /j /
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