HomeMy WebLinkAboutS2018-0209 - Permit Application526 ��-a2aq
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
PLEASE PRINT OR TYPE
CITY OF NEWPORT BEACH
BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
C -Q Yn n 1
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION
SWIMMING POOL ,�? SPA ntPOOL FENCING ❑ DRAINAG�
Check Am3roariate box for ADolicaant d (-kn.
3. OWNER'S NAME I� NS -T FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
Tao 1 Lo-(- tidal uka+/ .
LICENSE NO.
ADDRESS IENGINEER'S
E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICE En n
No. � ass3
ADDRESS -
CONTRACTOR'S E-MAIL ADDRESS
C TY STATE ZIP r
irk, c 1) o
IPHONE NO.
(- 74c=3giv
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
hs s'Iol$•o20`�, "t�•ot��2otiS.o3��
�L'11`1•�,ot$
Forms\Pool spa appl (rev3-04).xls
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