HomeMy WebLinkAboutS2018-0028 - Permit Application4 fisc WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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 S W ( (ILMI
SWIMMING POOL IN SPAS],
Check Appropriate box for Applicant
t SPA 14 Y, 2
ESTIMATED $ VALUATION Lko ) OJb
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
R&wI\)hV-yr tANSI�N^11a't1
ADDRESS
OWNER'S E-MAIL ADDRESS
'R 2
ro 'Poc'IIPI cv;, VN ej
CITYn - STATE ZIP
6 wPJ`� e j, C !&\ `� 2 (p(,U
PHONE NO.
4�/ Sl}(- 1226
❑ 4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
c,t ,or
&77 tooS6
ADDRESS
l"Zol N TUs-}
ENGINEER'S E-MAIL ADDRESS
n
CITY STATE ZIP
AvAr, k c I, CA Z,o s
PHONE NO.
1 -1 f463D-4:lCO
5. CONTRACTOR'S NAMES
BUSINESS LICENSE
STATE LICENSE
1
-70-7 I oqxClass
No.
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
Sa.i.. cA,
PHONE N0.
;E USE ONLY
PERMIT NO. SZ `P ^ 0c)PLAN CHECK NO. 111
POOL P/C FEE $
DRAINAGE P/C FEE $� �/y
Forms\Pool spa appl (rev3-04).x15
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