HomeMy WebLinkAboutS2017-0166 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
0619
CITY OF NEWPORT BEACH F7q '���
BUILDING DIVISION �,Zo Q - DI U& �
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
7o b W. A -4c-
11411
BLOCK
TRACT
2. DESCRIPTION OF WORK SPA -7 , JC S
ESTIMATED $ VALUATION '45r?�v�
SWIMMING POOL ❑ SPA [t - POOL FENCING [_1 DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'SNAME`., LAST FIRST
Y^ I I%FA 1.144-. tb t.(. ] 0-�
ADDRESS
OWNER'S E-MAIL ADDRESS
31 r"a%¢Ek
C,60.1,
CITY STATE ZIP
PHONE NO.
/401 PT- eh 14, (d6
'I ( 4-16 3j-- eco
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
LAc-k*tP— `fsbb
f'g6SI<
ADDRESS
ENGINEER'S E-MAIL ADDRESS
I Lot Tuz c cf4 b4e-
-tuba (° q"t- &4• ktcA�KC.. co«.4,
CITY STATE ZIP
PHONE NO.
/4, -At, EI PA CA gtfb'I
`((d— LSI-(p(ob
5. CONTRACTOR'S NAME
BUSINESS LICENSE
T
STA,, E LICENSE
/Ty�D u.4ti u 3 gy e6LS
No.4416y 90 Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
`
){roc-, C Q& -k
CITY STATE ZIP
PHONE NO.
;E USE ONLY
PERMIT NO.
�31•I�
PLAN CHECK NO. Lro No04
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls