HomeMy WebLinkAboutS2016-0156 - Permit Application�%lroC)IV-je
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATIONS
SPA OOL FENCING`DF�ktN46,
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
V�
ADDRESS
OWNER'S E-MAIL ADDRESS
J ` - P -O-( 7
CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
JEFIC
LICENSE NO.
X733
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
1'�� C'�• 128-7
PHONE N0.
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i r,
5. CON CTTOOR'S NAME
BUSINESS LICENSE
STATE
STATELIICENSE
l�C �� ���J
UT -6 +C�s
lNo.�
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
STATEZIP
X26`72,
PHONE N0.
9�i���crlv)'
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).x15