HomeMy WebLinkAboutS2018-0193 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACHso G
BUILDING DIVISION /!
PLEASE PRINT OR TYPE �� V
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
ILEGAL DESCRIPTION I
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL
v
ESTIMATED$ VALUATION
SPA/ ,P001 FENCING F-1 DRAINAGEO
Check Appropriate box for Applicant
3. OWNER'S NAME'' hIV–LAST FIRST'
0vG�
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY ATE ZIP
PHONE NO.
C D►'\ -t Cc X170 ZS—
N9 S-1 &/
4. ENG R'S N ME / LAST FIRST
e cf t L V-1
LICENSE NO.
-7 `x°03
ADDRESS
ENGINEER'S E-MAIL ADDRESS
1. 2-0 1 � V S-I^�
CITY STATE ZIP
Aije-4,,vv-- Cc._ qez&c�
PHONE NO.
7Ig103zGvow
5. CONTR�TOR'S NAME
BUSINESS LICENSE
STA E LIC N E �//7�
N 0 LS
No. Class
AD E�./8�8
(Al
CONTRACTOR'S E-MAIL ADDRESS
Cl Y STATE ZIP
1037 A- ®✓l>�— Ce_ 976? 7
PHONE NO.
IM 573 S�
7ICE Z,SUSE ONLY zERMIT N0.
LAN CHECK NO. L12 l
P/C FEE $
P/C FEE $
spa appl (rev3-04).xls