HomeMy WebLinkAboutS2018-0127 - Permit Applicationtea`" R WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
.. A 72
CITY OF NEWPORT BEACH r
' Jam,' BUILDING DIVISION
1. PROJECT ADDRESS (NOI�M<LING ADDRESS)
3 '-1 5 V Y-6 N�t� Gr �e►4C%l C P
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK (�15{�(� �ri^n`\� Pao' SI 3. T-j?6rirP
(nyon�i VA( W (n4StAv� ESTIMATED $ VALUATION 1 O4000
SWIMMING POOL �V SPA [ POOL FENCING DRAINAGE
Cheek Annrnnriate hox for Annilcant
rl 3. OWNER'SN��A��MMME����AA LAST FIRST
R'�1
tSl `'- Lo c r"L V\
ADDRESS
OWNER'S E-MAIL ADDRESS g
�� Lam-tcoaSoiail. '
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CITY STATE ZIP
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PHONE NO.
4. ENGINEER'S NAME LAST FIRST
OVP-( 5 J oV5 a4,rsur. Pa„viT)
LICENSE NO.
C, 5£sl6�1
ADDRESS
l 4,0 L p Y a( S Sc� n+c 1=e
ENGINEER'S E-MAIL ADDRESS
6 Wa}e> S� a �a hs(► I �n . �o
CITY STATE ZIPPHONE/
5 d �Gt VL4 PxA� l GA cf'2 6�
O.'', _ e�
bS ^/7W [
5. CONTRACTOR'S NAME qo, re4mcui C_ Way
BUSINESS LICENSE
STATE LICENSE
Uf
No. Class'
V� N
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
%l of Nx& a k&- ,cam
CITY STATE ZIP
G k
HONE NO.
-71 (F 3� b 3 6
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Farms\Pool spa appl (rev3-04).xls
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