HomeMy WebLinkAboutS2016-0158 - Permit ApplicationWORKSHEET FOR POOLISPA PERMIT APPLICATION
a CITY OF NEWPORT BEACH
(£ BUILDING DIVISION
of cnec PR!%'T
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
FLOOR
SUITE NO.
I--}- b
CWD 0
OWNER'S ADDRESS / A �� j �n
CITYj�^/,
LEGAL DESCRIPTION
ZICP j
No. UNITS
LOT BLOCK
TRACT
q �CITY/y p P
C(T I l-' �)
2. DESCRIPTION OF WORK Z-
— /ESTIMATED $ VALUATION S-21� r3 L'3
SWIMMING POOL �/ SPA Ly" P PA--nruFa
3. OWNER'S NAME LAST FIRST
PHONE NO.
OWNER'S ADDRESS / A �� j �n
CITYj�^/,
STATE
ZICP j
4. APPLICANT'S NAME LAST FIRST
CLL / "-1 j �
PHONE NO.
�U� �� ,' (? 6 /
APPANT' �ADDRESf (v 1 S a-
q �CITY/y p P
C(T I l-' �)
STg E
zip
9 263
5. ARCHITECT/DESIGNER'S NAME ,LAST FIRST
STATE LIC. NO.
ARCHITECTIDESIGNER'S ADDRESS
CITY STATE ZIP
PHONE NO.
6. ENGINEER'S Nr/E LAST �� FIRST
Gt C. U71r7
STATE -
G C. NO,
( "1 6
ENGINEER'S ADDRESS
VD -1D I V l spa
CITY STATE ZIP.
qkojt', �
PHONE NO.
7q6 varj
7. CONTRACTOR'S NAME
c�„tew, usrnr `ls
LIC. CLASS
C
STATE LIC. NO.
CONTRACTORS ADDRESS
�1° ��
ZIP
CJTY0� l STATE ZIP
`>> I/`Lli', !-SNI
PH ,-2 iAtl�3,
(h' �f
APPLICANT'S E-MAIL ADDRESS
NEWPORT BUS, LIC. NO.
POOL/SPA ITEMS
NO.
WATER SERVICE
GAS SERVICE
WATER HEATERS
P -TRAP
ANTI -SYPHON VALVE
ELECTRIC SYSTEM
OTHER MISC.
OFFICE USE ONLY c', I� `
PERMIT NO. '.)O -'1 V o\S Cj
PLAN CHECK NO. q I b — \ U
PLAN CHECK FEE $