HomeMy WebLinkAboutS2018-0191 - Permit Application2q --o t16, -01C-t i
oekry< WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
(NOT MAILING ADDRESS)
2. DESCRIPTION OF WORK R Cy��or�o 1 C��1S� ner Cv o mw yiop` G A cn y2®
C,r -Fire 12xi ESTIMATED $ VALUATION S$t aa0
SWIMMING POOL ❑ SPA [- POOL FENCING ❑ DRAINAGE ❑
Check Aoorooriate how fnr Annlirant
3. OWNER'S NAME LAST FIRST
ADDRESS
O1WNttER'S E-MAIL ADDRESS
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6L—_ Gin Zcb c, lao. 0,
CITY STATE ZIP
PHONE NO.
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
�T
I �-O 't (`� 6� ,
CITY STATE ZIP
PHONE NO.
Jsl��,�. (A-, 1-Z l
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5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
�Nn.(o`�IY ClasGj
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
i(o-40 S �w �u GrckI
CITY STATE ZIP
PHONE NO.
—T,—m "&„1/.)— 661- WZ991 I
Ejl,(-+q —os—V°�
USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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