HomeMy WebLinkAboutS2013-0032 - Permit ApplicationJ-w) V� / 6GG r WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
°"Ewre CITY OF NEWPORT BEACH
4 BUILDING DEPARTMENT 526� �_ 1�17�2'
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
1 5- 1 aCX)0.1 bpi\(6-1 �J0. ?6eC CDCO .
LEGA ��ESSCRRIPTION
LOT I I f CU!, 6 BLOCK TRACT/� �
2.
OF
SWIMMING POOL
SPA L9'
Check Appropriate box for Aonlicant
L
� 'l 4
Z 3 . / 'ESTIMATED $ VALUATION
POOL FENCING I/
:.. ., -I;; Wig.
iffill
❑ 3. OWNER'S NAME . LAST FIRST
—. 4t (L �-l0 Nits 240 cY- Cu,T-
ADDRE_SS
S6 �)- -2-CQ 'S-r
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
LAGUNA
LAG6cm CA glb5-�
PHONE NO.
q'{o L+gy i3yS-
4. ENGINEER'S NAME LAST FIRST
ew -&--u- ��.
LICENSE NO.
3
ADDRESS
51 SloiNNk Gtm� - .A1LS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
C-iLj-�, DotA C' ON-7LFI
PHONE NO.
t02)b335 y-3b
5 CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Nc � LIt ClasL
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
aZ ?moo 7s
CITY STATE ZIP
LACuNA 9 cri CA9�&n
PHONE NO.
L19q ( 9q�
Z USEn0 aw�I
x ��
PERMIT NO.
APR 0 2 2013
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls