HomeMy WebLinkAboutS2018-0043 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PER, MIS APPLICATION -
CITY OF NEWPORT BEACH
BUILDING DIVISION C7n19-nru -7
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
2,0 L
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK L-
.
SP4- r - ESTIMATED $ VALUATION
SWIMMING POOL 0"' SPA J onnI r�oni�r E3
Check AoorooriatP hnr fnr Annlimm.4
7 3. OWNERS NAME LAST
,G���
FIRST
/�0Rr� ADva�a�
iia-^ l3-
ADDiREcSSS
OWNER'S E-MAIL ADDRESS
Q
CITY STA E
ZIP
9241f-
PHONE NO.
4. ENGINEER'S NAME LAST
L�` oi>D
FIRST
LI/CENSE NO.
(o-j7&�
rr ADDRESS \\ r� /
o
ENGINEER'S E-MAIL ADDRESS
1.2- t r3 (V S r�
CITY STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE STATgqE LICENSE
(� CVM
q%Z/t�
No.
ADDDDRESS/
CONTRACTOR'S E-MAIL
55�
ADDRESS
CITYSTATE
-", FaP ,-
ZIP
07430
PHONE NO.
.4y3. 6
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $ 6Z 0 5D
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls