HomeMy WebLinkAboutS2018-0099 - Permit ApplicationiYW➢�
,� WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION SaOi8-p®gg
..�.< CITY OF NEWPORT BEACH
BUILDING DIVISION ul
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT. MAILING ADDRESS)
4xHa4
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION / v1 r' -'t✓
SWIMMING POOL SP e,ePOOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Aaalicant
3. OWNER'S NAME
LAST
f�7�
FIRST
1 dr ��12
ADDRESS
Aro�5
OWNER'S E-MAIL ADDRESS
10 (
'/1/
(qlh
CITY f
STATE
�'
ZIP
92��
PHONE NO.
9 6,7
GIAM
4. ENGINE 3 S NAME
LAST
FIRST
LICENSE NO.
ADDRESS /
ENGINEER'S MAIL ADDRESS
CITYST
J/ (?/ '17)
TE
111AY
ZIP
Auo
PHON N
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5. CONTRACTOR'S NAME
BUSINESS LICENSE
lffv-
STATE LICENSE
A110class
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No. V�
ADDRESS
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CONTRACTOR' E-MAIL ADDRFGSS
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CITY
.TATE
ZIP
PHON 7
A
:E USE ONLY
PERMIT N0. �{V
PLAN CHECK NO.
v
POOL P/C FEE $
DRAINAGE P/C FEE $
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