HomeMy WebLinkAboutS2016-0009 - Permit Applicationy{YPpF
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PLEASE PRINT OR TYPE
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY UI NEWPORT BEACH Q�/ OIfn r„fyeygd
BUILDING DIVISION VG• { VIC V�JV''
1. PROJECT ADDRESS (NOT MAILING ADDRESS),
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF
!/� S(_ ESTIMATED $ VALUATION 7�
SWIMMING POOL L�/ SPA Ly' Poatf-E- El
Check Anoronriate box for Applicant
3. OWNER'S NAME LAST FIRST
ADDRESS
15-7
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PH/O�NE NO.
�'+^^ / �r� /
24—
7
4. ENGINEER'S NAME LAST FIRST
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LICENSE NO.
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8�-0 7 3
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
110 X-4 t, _. Cc� 512--8'07
PHONE NO.
`7 / rl6 .?o G»b
1p 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Nokl Sum CIaYs.,3
ADD ESS
CONTRACTOR'S E-MAIL ADDRESS
7(( vf, 1? S�
CITY STATE ZIP
PHONE NO.
s,v- Aep,,- C� s z�
Wj&-3
;E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $ L , Z, • J -O e
DRAINAGE P/C FEE $ k.1 [ Ul 11--1
Forms\Pool spa appl (rev3-04).xls