HomeMy WebLinkAboutS2017-0162 - Permit Applicationr7 `1
LEGAL DESCRIPTION
LOT
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
U ADDRESS) A nA
BLOCK
2. DESCRIPTION OF WORK A
1
ESI ED $ VALUATION 301C)
SWIMMWQ onn SPA F � DRAJNAGE n
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITYL STATE ZIP
Ica f W 26 zs-
PHONE NO.
4. ENGINEE A E LAST FIRST
LICENSE NO.
, Vl
1 .a y! '
ADDRESS
ENGINEER'S E-MAIL ADDRESS
4® LcxAJ/4-g, �.
pi 1'
CI STATE G, /ZIP
ONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENS
a �3
��- c�� ��f
No. ulass
AD R SS �j �y
CONTRACTOR'S E-MAIL ADDRESS
CITY q"�''/� //^STATE p f/ZIIP
/„I IlA (A �'�✓ //
PHO E N�O�
PFA
:E USE ONLY
PERMIT NO.
PLAN CHECK NO. J
POOL P/C FEE $ 21:�)94-
DRAINAGE P/C FEE $
Forms\Pool spa appl (mv3-04).xls