HomeMy WebLinkAboutS2014-0104 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION SZd 12 J�y3
@F%r§"F�CITYOF NEWPORT BEACH Cn�,Pj/ BUILDING DEPARTMENT
PLEASE PRINT OR TYPE 7,0
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
roe & My 4�7 C� ���0
LEGAL DESCRIPTION
LOT BLOCK TRACT oc*\,L'/\4
2. DESCRIPTION OF WORK__Cam! 917 / T 1 c
------------ -------------------- - ----------
/�� -` aL - -- �d`i ________ ESTIMATED $ VALUATION
f1`0Sj%r v7%�r-0�!
SWIMMING POOL [Ty SPA POOL FENCING-- DRAINAGE
Check Annrooriate hnx fnr Annlican4
/�
3. OWNER'S NAME
LAST
FIRST
p /mil �'
r G o K'
ADDRESS
—/f{��/� ��y (��//� {/'//�� y/�
OWNER'S E-MAIL ADDRESS
CITY
A/e oly* �a�ch
STATE
Cif
ZI PHONE NO.
qa6�"� 9 " y 0 .- 70v
4. ENGINEER'S NAME
ei
LAST
FIRST LICENSE O.
ADDRESS
3 1 A�1'f�Jc`G�a N
ENGINEER'S E-MAIL ADDRESS I �O
lV J
a rr-U
CITY
scto ��
r[]5.
STATE
c
ZIP PHONE NO.
7a17a 9�`9- ��
CONTRACTOR'S NAME / {/�/fie �i// /�
e enilf S cl lV��%�G�W
BUSINESS LI/CENSE STATE LICENSE
5pC �iCy r(f No.
ADDRESS
O A ` ✓ urt- too
.
Class
CONTRACTOR'S E-MAIL ADDRESS
-4r6?Ak oswfandscapigcpGoner
J
7c, r�r t
STATE
ZIP PHONE NO.
USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE
DRAINAGE P/C FEE $
�Szv(z. a0N3'PAID
fiwZ • 20/ MAY 0 1 2012
BEACH
s
Forms\Pool spa appl (rev3-04).xls