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HomeMy WebLinkAboutS2012-0038 - Permit ApplicationWORKSHEET FOR POOL COMB(NAT ON PERMIt APPLICATION2 ww"a !CITY OF NEWPORT BEACH ` BUILDING DEPARTMENT 4w4a.PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) �,—/�:�dr��� Ir Fc kd C��I Cr` LEGAL DESCRIPTION LOT BLOCK TRACT 2. DESCRIPTION OF WORK SWIMMING POOL [X SPA ❑ Check Appropriate box for Aoalicant ESTIMATED $ VALUATION POOL FENCING ❑ 51 � Ca�hcl l I nGl ©r DRAINAGE ❑ 3. OWNER'S NAME jpLAST EIRST C \-)IE N4 ADDRESS OWNER'S E-MAIL ADDRESS CITY \/ STATE ZIP PHONE NO. ® 4. ENGINEER'S NA E LAST FIRST � LIC NSE NO. '� Ae' l�`I52�" ADDRESS ENGINEER'S E-MAIL ADDRESS vzo J CITY STATE ZIP PHONE NO. ® 5. CONTRACTOR'S NAM BUSINESS LICENSE STAT LICENSE 1Mv > No. Class ADDRESS CONTRACTOR'S E-MAIL ADDRESS CITY (( STATE ZIP 11 live �l"[ cc� �( PHONE NO. --cA� G1 Akz �{ OFFICE USE ONLY PERMIT NO. 24 (2 • 6�/ 1 PLAN CHECK NO. POOL P/C FEE $ DRAINAGE P/C FEE $