HomeMy WebLinkAboutX2018-0962 - Permit Application (2)""��' WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
��ri, CITY OF NEWPORT BEACH
BUILDING DIVISION Y To I d- ®°i b 7,
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT a0l BLOCK TRACT
TION
2. DE OF
l WORK
�-Y�II^
SWIMMING POOL ❑ SPA
Check Appropriate box for Applicant
_ ESTIMATED $ VALUATION
POOL FENCING ❑
DRAINAGE ❑
3.
OWNER'S NAME
LAST
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
C4-
4 z 67tv l
7l - 54ta a eco
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
No41IC
U C%la�a
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
Gd
rsf
cove
9,,x b� ro
1PHONENO.
7t4-5 4- 5- cge)4
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls