HomeMy WebLinkAboutS2017-0083 - Permit Application1001-,2017
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION 093
CITY OF NEWPORT BEACH
BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
-SC,D -
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION 37i 0-C>-
SWIMMING POOL El�/ �PA-f] PEP18`".ea nRnwnr,F n
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3. OWNER'S NAME LAST FIRST
ADDRESS
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CITY - \ STATE ZIP
PkiOVE N� 3 b a
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LICENSE NO.
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PLEASE PRINT OR TYPE
1001-,2017
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION 093
CITY OF NEWPORT BEACH
BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
-SC,D -
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION 37i 0-C>-
SWIMMING POOL El�/ �PA-f] PEP18`".ea nRnwnr,F n
Check Anorooriate box for Annlicant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY - \ STATE ZIP
PkiOVE N� 3 b a
NAME LAST FIRST
4. ENGINE7A-6Ah6lL-
LICENSE NO.
G--7 (,J�
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
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CITY ATE ZIP
PHONE NO.
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CONTRACTO AME^//
BUSINESS LICENSE
STATE LICENSE LICENSE
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No.61b C S'
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CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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OFFICE USE ONLY ��%%//�� ✓� (x?/'
PERMIT NO.
PLAN CHECK NO.�a��i1
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls