HomeMy WebLinkAboutS2018-0139 - Permit Application (2)o4fi4"° r WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION 4d
CITY OF NEWPORT BEACH suit
BUILDING DIVISION
NLI-AJt YKIN I UK 1 TYC
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
Zt �, /,�' �r�p
LEGAL DESCRIPTION
LOT
BLOCK
TRACT
2. DESCRIPTION OF WORK N O%k> V IUB N! {iw J� kk- (
C.� ✓�!E / f 0,- ESTIMATED$VALUATION
SWIMMING POOL Ly' SPA ❑ POOL FENCING ❑
Check Appropriate box for ADDlicant
Q
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
7\
(Z , 11?S 1^� J ,--s
STATE ZIP
PHONE NO.
®CIpTY
/j
BV ? 13 CTS
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
p
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
J-1&VvV \ Y
L j
No.Iz�(oq,� Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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�Zf F-dSO \� 2 k4�
CITY ZIP
PHONE NO.
nn /STATE q
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Z USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
j1�05,wt