HomeMy WebLinkAboutS2017-0196 - Permit Applicationa� `"P ° WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
x,n: CITY OF NEWPORT BEACHJ�.2y�q�
BUILDING DIVISION
PLEASE PRINT OR TYPE (� I� • ✓
1. PROJECT ADDESS (NOT MAI G ADDRESS
IN
I��4 - -
LOT
2. DESCRIPTION OF WORK
SWIMMING POOL
BLOCK
TRACT
ESTIMATED $ VALUATION 3 4} 0-�-Z7
SPA [� Re9L, E CWG—Q — DR}CfI4ROE-B�
Check ADDrODriate box for Aaalicant
Ei 3. OWNER'S NA LAST FIRST
ADDRESSOWNER'S
(3
E-MAIL ADDRESS
CITY k STATE �j ZIP
PHONE NO.
,374
4. ENGIN R'S NAME
LAST FIRST
LI
ICEN E NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
c N- ST (-i
CITY
�- STATE ZIP
CA- X287
PHONENO.
7/tl %0D (o 10-0
=ORS
5.C TRACrOnR'S NAME
BUSINESS LICENSE
STATE LICENSE/�'
i LSA
NogAil7b cCO
ADDRESS
4\3
CONTRACTOR'S E-MAIL ADDRE=SS y
�frsl-s��'�"f O�`t•v. �Yi
t r
CITY STATE ZIP
� 2�7v
PHONE N
%ilej Fjd o qos-�
OFFICE USE ONLY
PERMIT NO. +'u I -j OI�I V
PLAN CHECK NO. VIr-)
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls