HomeMy WebLinkAboutS2018-0212 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK JW�l��1✓ �QOG . f%G4• �� DI'
ESTIMATED $ VALUATION-- 102P
SWIMMING POOL SPAEaPOOL FENCING ❑ DRAINAGE
Check Appropriate box for Applicant
3. OWNER'S NT�IM`E LAST FIRST
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OWNER'S E-MAIL ADDRESS
ADDRESS
CITY STATE ZIP
PHONE NO.
L lecj rD/L(- G6 4C44 CA 941:�,6cD
/2 -- 202 - q4-5 z-
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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fr,2:NEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
S
N . Ca
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
/3 4(
CITY STATE ZIP
PHONE NO.
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2/1� �Z72
CE USE ONLY
PERMIT NO. S Upp��
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PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls