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HomeMy WebLinkAboutS2016-0083 - Permit ApplicationSzotie - 0093 o, `" "m WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION a A , e�*, CITY OF NEWPORT BEACH BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) 46 6? R-T�) LEGAL DESCRIPTION LOT BLOCK TRACT 2. DESCRIPTION OF SWIMMING POOL SPA Imo' Check A ro date box for Applicant ESTIMATED $ VALUATION PnnI FENQluc-❑ 9 pP p 3. OWNER'S N E LAST FIRST (f t6�1 C7 ADDRESS OWNER'S E-MAIL ADDRESS ,A&D(0 \`ix-& l CIT��YSlAATE ZIP PHONE NO. q rV Gnl►�( ` 119A A-- 6L 4. ENGINEER'S NAME LAST FIRST LICENSE NO. I qoo3 1 �U��ba�iS ADDRESS ENGINEER'S E-MAIL ADDRESS )Q�o I i\[.�� CITY STATE ZIP c PHONE NO. 71y63061vc) 5. CONTRACTOR'S NAM/E�� �p BUSINESS LICENSE STATE LICENSE NoIG�%7�� Class ADD ESS CONTRACTOR'S E-MAIL ADDRESS ZIP CCS/ (CE �2&7 z_ PNO77 8 3D ©9 lel-V ;E USE ONLY PERMIT NO. PLAN CHECK NO. POOL P/C FEE $ DRAINAGE P/C. FEE $ Farms\Pool spa appl (rev3-04).xls 2°(S • b ?-q mf