HomeMy WebLinkAboutS2018-0116 - Permit ApplicationS;0i9 61tb
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
m
ml
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
T�eAGIn
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4 Or�
LEGAL DESCRIPTION
LOT BLOCK
TRACT
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% Vd �� d I
y 6
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2. DESCRIPTION OF WORK
7 Q fda I
ESTIMATED $ 7VALUATION
SWIMMING POOL SPA �
POOL FENCING DRAINAGE ❑
Check Appropriate pox Tor AppucanL
LAST
FIRST
rl 3. OWNER'S NAME
;cll�
ADDRESS
OWNER'S E-MAIL ADDRESS
a Svp4AtIAL
CITY STATE
ZIP PHONE NO.
�ro-Boi—Slis
ti-aw(�6A 'is CA
4. ENGINEER'S NAME LAST
FIRST LICENSE NO.
G�6SG
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C
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE
ZIP PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE STATE LICENSE
drat 3? �
No. Class
v��Jooti CaKc�A�
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
epl V / 0-sa.sa Val �a 5�
CITY STATE
tLA ��� IS'� kid CA
ZIP PHONE NO.
W`?l 1411 -o��s" y1/l7
USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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Forms\Pool spa appl (rev3-04).zls