HomeMy WebLinkAboutS2018-0130 - Permit Application`"p n WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION S2
o�x„° CITY OF NEWPORT BEACH 0Ig ' 0130
BUILDING DIVISION
1'LMAOM rR11Yl VR i rrc
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
Z'fog ^ I-vre $ ,D -r.
LOT
2. DESCRIPTION OF WORK 5ul1Yl1 ;
6y
SWIMMING POOL 04”
SPA 9
Check Appropriate box for Applicant
TRACT
' ESTIMATED $ VALUATION 127
POOL FENCING ❑ DRAINAGE ❑
OWNEER'S NAME LAST FIRSSTT-
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ADDRESS
OWNER'S E-MAIL ADDRESS
ZYcg 177w- a red- P-('
CITY STATE ZIP
PHONE NO.
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> �
i/9 -%s/'710
ENGINEER'S NAME LAST FIRST
Fe',c,L Fi? ;year= j Lacher � o/7�?
LICNSE NO.
ADDRESS v
NGINEER'S E-MAIL ADDRESS
I ZnI N. Ave --
CITY STATE ZIP
PHONE NO.
CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
[®u s con's 10 'e•L��10 Al
7
97 ?OC>6L39'7.�
No.)0/70%3 Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
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PHONE N .
79y Sys=83L�
:E USE ONLYto
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $ -7 cl
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).Xls