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HomeMy WebLinkAboutS2018-0169 - Permit Application�FJDkPR 1301 J 0 O F WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION U S 2I0 • a(4ITY OF NEWPORT BEACH BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) 1 LEGAL DESCRIPTION LOT BLOCK TRACT 2. DESCRIPTION OF SWIMMING POOL Ej,-�' SPA Check Awronriate box for Annllrnnl losolm, .s—S- A 5(4b b ESTIMATED $ VALUATION �-d© D POOL FENCING ❑ DRAINAGE ❑ 3. OWNER'S NAME LAST FIRST e ADDRESS OWNER'S E-MAIL ADDRESS G -t, CITY -- STATE ZIP PHONE NO. �w pry �• zb)j 17 6to 4. ENGINEER'S NAME LAST FIRST LICENSE NO. e � -h ADDRESS ENGINEER'S E-MAIL ADDRESS CITY STATE ZIPTNE NO. ` 5. CONTRACTOR'S NAME BUSINESS LICENSE LICENSEZ FSTATE ADDRESS Class Y7 CONTRACTOR'S E-MAIL ADDRESS CITY p\ � \ 1 C) STATE ZIP PHO ENO. OFFICE USE ONLY PERMIT NO.S ZU _ � / I 1 p W PLAN CHECK NO. CS� ' di POOL P/C FEE $ DRAINAGE P/C FEE $ Forms\Pool spa appl (rev3-04).xls e4g5