HomeMy WebLinkAboutS2018-0026 - Permit Applicationcna"Pei-
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
'I. PROJECT ADDRESS (NOT MAILING ADDRESS)
\
LEGAL DESCRIPTION
LOT 5 ( BLOCK TRACT 1-1 _5C io
2. DESCRIPTION OF WORK ( � �� ( 1�i1,C �l �2 Y� r)
ESTIMATED $ VALUATIONS
SWIMMING POOL( SPA POOL FENCING ❑ DRAINAGE L�
Check Appropriate box for Applicant
3.
OWNER'S NAME
LAST
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
-De-I--
CA
ct JA 6 L4
RL+ 3,5( -641-9)c)
4.
ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
c)0 0
6`1 5
ADDRESS`
ENGINEER'S E-MAIL ADDRESS
1 9,A
l �i a CaC
I
U
CITY
STATE
ZIP
PHONE NO..
�,l
c
�} (�
l as t7
n
lqW30-- leo
❑ 5.
CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
�j h
CITY
STATE
ZIP
PHONE NO. Lr9
l169-�
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $ ✓5�
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls