HomeMy WebLinkAboutS2016-0188 - Permit Application""' WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
4 CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
2,
LEGAL DESCRIPTION'
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL �Y SPA
c.V
Check Annrnnriate hnx fnr Annlirant
_ ESTIMATED $ VALUATION
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME
lid "
LAST
C1
FIRST
d:, O� ` � �
ADDRESS
OWNER'S E-MAIL ADDRESS
i1a2ic-rn@%iomeavk&f (60AL)CO, m
CITY
k
STATE
�
ZIP
PHONE NO.
�0 to
❑ 4. ENGINE R'S NAME
LAST
Flf�sT
LICENSE NO.
ADDRESS �-
--1
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP`/] PHONE NO.
5. CONTRACTOR'S NAME
aS S �
Pool
.1 "BUSINESS LICENSE STATE LICENSE
ivy z�
L
Slurn
ADDRESS
No. Class 3
CONTRACTOR'S E-MAIL ADDRESS
i? 0, E -2f) 0�3
70
oafs .co"
CITY
STATE
a
ZIP PHONE NO.
q(319+3 '7tow
7qa - / S (, R
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
FormslPool spa appl (rev3-04).xls