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HomeMy WebLinkAboutS2017-0131 - Permit Application (2)v WP a�{cwoef°s PLEASE PRINT WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION CITY OF NEWPORT BEACH S2,0Il-0�� BUILDING DIVISION "I. 1'KUJtU I AUUKtJS (NOT MAILINGADDRESS) 107 (56ecII f F i "I-f-,ul LOT 2. DESCRIPTION OF WORK BLOCK SWIMMING POOL Check Appropriate box for ADDlicant TRACT I� ESTIMATED $ VALUATION POOL --FENCING--© DRAINAGE -O- 3. OWNER'S NAME LAST FIRST r Vl/i/10 ADDRESSOWNER'S i o 7 j Ci �f E-MAIL ADDRESS o reel CITY STATE ZIP PHONE NO. S 3sl/5l 4. ENGINEER'S NAME LAST FIRST LICENSE NO. ' , ed ekkc4c l-,, C-tt-I s 001 ADDRESSy. ENGINEER'S E-MAIL ADDRESS l�C TUSI 0 IV CITY STATEyy ZIP �l i✓\,-- �7OU PHONE.NO. ����o �I�« 5. CONTRACTOR'S NAME , ccD BUSINESS LICENSE STATE LICENSE �3 rt.N 4 OOL OLY6 06 Class ADDRESS4'Ae,,vi CONTRACTOR'S E-MAIL ADDRESS l� STATE ZIP PHONE NO. 71_ Sso' Z70s OFFICE USE ONLY 7�� / PERMIT NO. 32v PLAN CHECK NO. POOL P/C FEE $ DRAINAGE P/C FEE $ Forms\Pool spa appl (rev3-04).xls