HomeMy WebLinkAboutS2018-0095 - Permit Application��-o -00cy s
i:ItYl'9
< WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
f'fGfM11P�S
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECTADDRESS (NOTMAILIN D RESS)
426
Au%jzy e,
IV(
LEGAL DESCRIPTION
LOT
BLOCK TRACT
2. D SCRIPTI N OF WORK,
LAST
IV(
`
ESTIMAT
$ VALUATION D-cLIg p
SWIMMING POOL
SPA
POOL FENCING
❑ DRAINAGE ❑
Check Appropriate box for ADDlicant
1. OWNER'S NAME
LAST
q FIRST
ADDDR SS
I
OWNER'S E-MAIL ADDRESS
CITY'
STATE_
(j�FIRSvTl
(
l
PHONE NO.
O
OJNGIN%IDIER'S NAME
`fit
LAST
LIICENSENOO.
Llol-�)--:s
pA�DjDR�}ES1S
ENGINEER'S E-MAIL ADDRESS
CITY
_
STATE
ZIPPHONE
�Qm
9
NO
`P. �y�
) q �-401 W
5. CONTRACTOR'S ME
\
BUSINESSWLICE1NSE
LICENSE
'S7T'AGTE
`4�►—R
NNc� Clas
AD ES
CONTRACTOR'S E-MAIL ADDRESS
°
CI
ST TE
ZIPTPHONE
NO.
l*3�
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
I2� 7---,7o
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls