HomeMy WebLinkAboutS2018-0083 - Permit Application4-�-o v�; -oocz; '�)
of •Nr°"s WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT A RESS (Nor MAILI�q�SS) V(
. rAve
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL ❑ SPA
Check Anoronriate box for Anniirant
_ ESTIMATED $ VALUATION
POOL FENCING
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESS
vr� G1a�lt 5 D�.
OWNER'S E-MAIL ADDRESS
'Ni °+
CITY STATE ZIP
PHONE
4. EN INEER S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONIR,gG,TOR'S NAME
BUSINESS LICENSE
STATE LICENSE
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE N0.
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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