HomeMy WebLinkAboutS2018-0139 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH suit - 013q
�4Utgk
BUILDING DIVISION
UK I YPt
1. PKUJEC:I AUUKESS (NOT MAILING ADDRESS) l
II, Sen I
LEGAL DESCRIPTION 1
LOT
BLOCK
TRACT
2. DESCRIPTION OF WORK i,I p(,%A % Y lir} e,V,j :�2 kk
V� !�5 ✓ Dt II ESTIMATED $ VALUATION
SWIMMING POOL SPA ❑ POOL FENCING ❑
Check Aoorooriate box for Aoolicant
If -
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
-S1 v\cz—
ADDRESS
OWNER'S E-MAIL ADDRESS
\
CITY STATE^ ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
N
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATyE� LICENSE
�7
ZinJ^i
l %
No.l�"l<O`t`� Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
ZZoso P�w`� 2��
CITY � STATE q ZIP
(/v
PHONE NO.
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.�a
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xis