HomeMy WebLinkAboutS2018-0031 - Permit ApplicationPRINT OR TYPE
S2LN- S�3�
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH ,
BUILDING DIVISION
RESS (NOT MAILINGSDRESS)
2 SG
LOT
2. DESCRIPTION OF WORK
SWIMMING POOL 2'
BLOCK
ME
SPA 9�
Chock Annrnnriafa hnr fnr Annlicanf
11903m
ESTIMATED $ VALUATION
3. OWNER'S NAME q�LAST FIRST
"ibp � �-'_J
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
6E�- 7310)04- 91ZO613
310 S7? h qj2-
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
� 7�
� f
ADDRESS '
ENGINEER'S E-MAIL ADDRESS
l 4, f S�
CI STATE ZIP
PHONE NO.
C9
3o (oma
5. RAACTO�R'S�NAME
L/ICENSEcs'p
BUSINESS LICENSE TATE�q
l/v> P� ?a-tl-s--
l lEm
No. q.�( -7(/ I ss
ADDRESS (nn�� 177
CONTRACTOR'S E-MAIL ADDRESS
C STATE ZIP
,S�j ggoel,-
PHONE NO.
qc(� E30 090j'
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
��2jGJ•?.11� 1
�wt�t