HomeMy WebLinkAboutS2018-0203 - Permit Application' n o
o¢ �'^'mn
� h
nyy
LOT
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION C SL I3 r. y alera or
/ CITY OF NEWPORT BEACH
/ % BUILDING DIVISION �) OZ Cl 3
TYPE
KESS (NOT
2. DESCRIPTION OF WORK .
SWIMMING POOL
BLOCK
SPA L7
Check Appropriate box for Applicant
l5z(
10 S *' \Z
ESTIMATE $VALUATION o�C�
POOL FENCING ❑ DRAINAGE ❑
0
3. OWNER'SNAME LAST FIRST
AA k C 1, c-� k l/,-!) � l�-ems✓
` ADDRESS yy
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
N �: U (� r h e C� C (, C' A-
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
� OCk(`� L� C
ICENSEjN(rO.
` Io,7
f z;;p
ADDRESS
'Z -C I
ENGINEER'S E-MAIL ADDRESS
�j
CITY STATE ZIP
tIvKl�ezOA C'LA– �]Z
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
S-(� Z (05o
CITY STATE ,ZIP IPHONE
2�✓\/A - A jZS$�
NO.
ggct
OFFICE USE ONLY
PERMIT NO. C '
c f l 10
�J PLAN CHECK NO.
IJ POOL P/C FEE $ C� � - 26} �6
r� DRAINAGE P/C FEE $ LZ2o '' t
�ts\Pool spa appl (rev3-04).xls I �T