HomeMy WebLinkAboutS2013-0073 - Permit Application'A WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION,,
"` CITY OF NEWPORT BEACH
BUILDING DEPARTMENT �-
PLEASE PRINT OR TYPE jfj' ' - �72e
1. PROJECT ADDRESS (NOT MAILING ADDRESS) a1 I /J + L
)4- �`�-�c'� � '')`'T�"L>t-i ;L9Udl'"C A�`'r� --CAS- '�/'�--�• ' YI
LOT
2. DWRIPTION OF WORK
SWIMMING POOL ❑
BLOCK
SPA
TRACT
ESTIMATED $ VALUATION
0
DRAINAGE ❑
Check Appropriate box for Applicant GI-l:�, f ( )l , V%ll
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
q4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
�tST OF N--A -5
CC+525
ADDRESS
ENGINEER'S E-MAIL ADDRESS
120) vs-T)r) plc
�ZA
CITY STATE ZIP
PHONE NO.
/lv C%—A 2-
(7IA-)63O--6100
Qj5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE�i
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
226�� 1/e�v a `�,5
u
CITY STATE ZIP
PHONE NO.
,o S 3 6 4
1 S 88"-'j-F0
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
1�33 �2-E)1�j
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls