HomeMy WebLinkAboutS2018-0189 - Permit ApplicationX0
-A/vTI UV4
DESCRIPTION
LOT
5201$—O/ Sq
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
VOT MAILING ADDRESS)
NX01917
2. DESCRIPTION OF WORK l?�DGP�i"!t fwE��fjS%tom, /✓ W (y
yI f✓G1N-SLJ%C�//UJ 7�GE O11/f'�Stf}TS ESTIMA
SWIMMING POOL ❑ SPA ❑ POOL FENC
Check Ancrooriate box for Anniicanf
3. OWNER'S NAME LAST FIRST
sg-+i ,z e,Er�UIty�
ADDRESS
OWNER'S E-MAIL ADDRESS
l53 fi-N7l G IJ¢} WAIF
(aSCtrt Vi�Ca S� H LU �zMD . CcwM
CITY STATE ZIP
PHONE NO.
1v9NP0,-' - - 5Eygcf-f Gllk %7- /, / 0
(cyll )- 3oc, - 3 ° q 3
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
-7ff/444- f3SL6NC-1
I� �i
No.5�7IJ4 Class�-si
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
2Z-7 CU Clr-Lr-lZ,N AVE
)PF)M- j*R [ CNC -(O a AiAIIVCAN-V P�ct-<,Cd M
CITY STATE ZIP
PHONE NO.
D�fiNCiE G!i '72-aL-77(4)44g-65.3
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
rormswooi spa apps (rev3-04).xls
L