HomeMy WebLinkAboutS2018-0224 - Permit Application2938-2018
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION 201 9-022N
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
fl Hor i®g's c)iz-i vF—
LEGAL DESCRIPTION
LOT BLOCK TRACT.
2. DESCRIPTION OF WORK �t�i1 Skil I ,- I <—� D61,5L4 D6
,&, IQ ( G� (_L2y�0 ST ESTIMATED $ VALUATION
SWIMMING POOL SPA 0-' POOL FENCING ❑ DRAINAGE ®--
Check Aooronriate box for Aoolicant
3. OWNER'S NAME
LAST
FIRST
ADDRESS
OWNER'S -MAIL ADDRESS
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I&git*AV QC*AWC"3S7C1cTP t.NET
CITY
STATE
ZIP
PHONE NO.
C}2•fo&0
(4CO-T.X-O-603i
F1 4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
SLY czws[�c7m04
No.n2lS ClassC-S
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
p
CITY
STATE
ZIP
PHONE NO.
Sampv r.t�kCLVt�n CA .
X290'1
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USE ONLY
u;lC71TjI1r►16a
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xis
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