HomeMy WebLinkAboutX2014-2611 - Permit Application (3)�Gv�rJ Ul�jl
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH �7 2oj 5 -b1 D%
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BUILDING DIVISION
Xzo14-7C>I I
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
M--�2 012fifiD 57
LOT
Y#a7XKyC41291OUK419
SWIMMING
BLOCK TRACT
,S X Gam%, S 3-7^) ESTIMATED $
SPA IQ POOL FENCING ❑
Check Aaaromiate box for Aonlicant
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESS�{�
OWNER''SADDRESS
/� y�
�E--MAIL
AD,�{�
CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
NEER'S E-MAIL ADDRESS
�2GENGI
1 - �s
CITY STATE ZIP
PHONE NO.
o� 1
5. CONTRACTOR'S NAME
BUSINESS LICENSE
sTfrE LICENSE
Nhtn,z, ` 4 Cti
No.55-9 5 77 Class 65'
ADDRESS - _
CONTRAC 'SE -MAIL ADDRESS
C► l 20
CITY STATE ZIP
PHONE NO.
Pr � fZ, +} CA- 0l�llt
� �s Ml0
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C. FEE $
394.)L
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Forms\Pool spa appl (rev3-04).xis