HomeMy WebLinkAboutS2018-0058 - Permit ApplicationoP0
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS
2.7 Z
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
:NOT MAILING ADDRESS)
i c CEf1"/ 5 /U
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL [pl-'
U FRE ,i
is'A l , / ESTIMATED $ VALUATION �� J
SPA ER PGOL-EEN. NG DRAINAGE
Check Aoorooriate box for ADolicant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
Z.-72q UcEl-12.1 3�v�
STATE ZIP
CITYCk)7-)
-�
PHONE NO.
_ qlA/7
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
l.._ bhGitL 77
&-7 (0
ADDRESS
ENGINEER'S E-MAIL ADDRESS
—(� , y
l 2-o 1 jJ .. 1 V , ' ' r—�
CITY STATE ZIP
PHONE NO.
Y,7
17/
5. CONTRACTORS NAME
BUSINESS LICENSE
STATE LICENSE
A ��e�2 �a��S
c53
�SA���; Z.
e
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
3 v1A
CITY STATE ZIP
NO.
-5 A C LL �./I �,rs7� <� 2 &'7 Z
THONE
;E USE ONLY (y �JD5% .
PERMIT NO. 514 -p°� 1.0� V^(/Jozi
PLAN CHECK NO. 01�(�/� d 1
POOL P/C FEE $
DRAINAGE P/C FEE $
Fo"s\Pool spa appl (rev3-04).xls