HomeMy WebLinkAboutS2017-0165 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
` CITY OF NEWPORT BEACH
BUILDING DIVISION
(NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT
2. DESCRIPTION OF WORK
t%��CiF Carr C:K.E Mt.10ESA 9fa2 ESTIMATED $ VALUATION M 600.E
SWIMMING POOL 2'�' SPA 3-' POOL FENCING ❑
Check Appropriate box for Applicant
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESSOWNER'SE-MAIL
ADDRESS
zit c�b G�
CITY STATE ZIP
PHONE NO.
IQ Gw tcAzr gseCAr
310-977- 70`{c(
ENGINEER'S NAME LAST FIRST
LICENSE NO.
DDRESS
ENGINEER'SE-MAIL ADDRESS
k?L&l w3. T�4;TipS�j
CITY STATE ZIPPHONE
NO.
A -o i5kiA Lk RZ&37
"7(Lk -630-CoIw
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
wAv3G tS1616
57-k%,501
No. rte' 7,105c( Class(,5,
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
Sq5 00wic 6-r
CITY STATE ZIP
NE NO.
PHOEM—
CA-
CA- R266�
Q5I-805.92-11l
:E USE N
PERMITRMITONLY
NO.. �( (,, /K^J
PLAN CHECK NO. \ �0
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls