HomeMy WebLinkAboutS2018-0176 - Permit ApplicationPLEASE PRINT OR TYPE
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH 52018-0I 11-P
BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
�N'l
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DICRIPTI\O� F RK a3�i1 ai�ZsL �- �A '
/0 071K ESTIMATED $ VALUATION �S�_
SWIMMING POOL W SPA �M POOL FENCING ❑ DRAINAGE ❑
Check ADorouriate box for Annlicant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
17ULL 69-A0Q1 G
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADD'RESS
ENGINEER'S E-MAIL ADDRESS
\--), Com. y 1 �p 1`l�
CITY STATE ZIP
PHONE NO.
ry
a �e� CA DIAD -1
l))14- CAO -0
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
CE USE ONLY
PERMIT NO. y`
PLAN CHECK NO.
POOL P/C FEE $ �✓ -� 1
DRAINAGE P/C FEE $ IJ `'e+ Lt-LcI
Forms\Pool spa appl (rev3-04).xls