HomeMy WebLinkAboutS2015-0108 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
r'
LEGAL DESCRIPTION
LOT
2. DESCRIPTION OF WORK
C�( Aoo 1 _LA
SWIMMING POOL ❑
H116Zy l
TRACT
)I.�s%e, e)(; ISL!2:-� d SE-o,, I'e,PLc�,
ESTIMATED $ VALUATION
SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check AnnrnnriatP hnr fnr Annlirmnt
3. OWNER'S NAME LAST
FIRST -------------
LA 0—
ADDRESS
OWNER'S E-MAIL ADDRESS
STATE
' i3f�zL z�AE-
ZIP PHONE NO.
9m
R'S NAME LAST
FILICENSE NO.
13, e�
C'M00�S
S9vq-zt9-
ENMAIL ADDRESSSTATE
FENGINEER
�. 6.; e T-7N
PHONE NO.
- 3�-�/0�CTOR'S
NAME
BUICENSE STATE LICENSE.Svc
,{L� IRL f I CL � ,
° l zqz 57i196 -S3z
No. Class COE-MAIL ADDRESS
w. c o-rI-e'1STAT/JE
CA
PHONE NO.�✓���
e _ o 7/y Gz � t
;E 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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