HomeMy WebLinkAboutS2018-0153 - Permit ApplicationQ� "° ° WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
' <..�.*^° CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS
2 5 p ( Sl fyekA ✓l fT
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Imo ` zz5to/4
%6 4� ESTIMATED $ VALUATION
SWIMMING POOL SPA EfhtB — ttdk 8
Check Annronriate box for Anolicant
3. OWNER'S NAME LAST FIRST
e:Emv 1 S __
ADDRESS
OWNER'S E-MAIL ADDRESS
2 Sv si cT�,29 vI s �,9-
ZSTATE ZIP
Poz, G D
PHONE NO.
`1qp. 3/ sire
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
POOL P/C FEE $i5
ADDRESS
ENGINEER'S E-MAIL ADDRESS
STATE ZIP
CITAA�/wl
PHONE NO.
710,ro6/p-D
5. CO TRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
17C ZS
Nol-S-VV7/ C�u
ADDRESS
2 5 �z �Yla lklallti-
CONTRACTOR'S E-MAIL ADDRESS
CIT�' STATE
� 7
PHONE N0.
;E USE ONLY
PERMIT NO.
q64t, w
PLAN CHECK NO.
POOL P/C FEE $i5
DRAINAGE P/C FEE $
Farms\Pool spa appl (rev3-04).xls
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