HomeMy WebLinkAboutS2018-0180 - Permit ApplicationS�-ON- 0190 �ti���
WO$K EET FOR POOL COMBIN4TIQN PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT LING ADDRESS)
1.1tole] 11
TRACT
2. DESCRIPTION OF WORK NOW kK&e"kX) 04-(::rrC-ee-rJ5' F064- q- SP4
ESTIMATED $ VALUATION [
SWIMMING POOL- SPA ;e POOL FENCING ❑ DRAINAGE )'
Check Aporoariate box for Aoolicant
3. OWNER'S NAME LAST FIRST
u" NgAqu (
ADDRESS
OWNER'S E-MAIL ADDRESS
2Z
CITY STATE ZIP
ow Po oref o4sV c44 qz(o 5 1
PHONE NO.
cmm - 8J$'62(f5Z
4. ENGINEER'S NAME LAST FIRST
'PA-pc`t9
LICENSE NO.
45oL
(�(1 (03
ADDRESS
� Li 0 N ' � us�u�Q1. ea � 20 �
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
®Ur.A X 2° 7
PHONE NO.
?�Y g� 7 ..?58.5
5. CONTRACTOR'SNAME
BUSINESS LICENSE
STATE LICENSE
I �
g.rJ�L%js
No.-t26317ClassG3
ADDRESS
-Co �l �1f�ca (2�CaCP g
CONTRACTOR'S E-MAIL ADDRESS
Ica wLuck a9Sfor,�.avl�lscr `,�
CITY STATE ZIP
L,cak � (.o 412.6 p
PHONE NO.
-7)q- 66Y 8882
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO. %3�I ' Zd 2
I 11 POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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