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WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
19 Castellina Dr
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Pool and Spa 463 sq ft
ESTIMATED $ VALUATION 40,000
SWIMMING POOL ® SPA ® POOL FENCING ❑ DRAINAGE
Check ADDrODriate box for Auolicant
❑ 3. OWNER'S NAME LAST FIRS
Wyson John
ADDRESS
OWNER'S E-MAIL ADDRESS
19 Castellina Dr
CITY STATE ZIP
PHONE NO.
Newport Coast CA 92657
714.335.6590
❑ 4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
Thompson Matt
86051
ADDRESS
ENGINEER'S EMAIL ADDRESS
1201 N. Tustin Ave
CITY STATE ZIP
PHONE NO.
Anaheim Ca 92657
714.630.6100
® 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Swan Pools
No. 440333 ClassC53
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
24512 Bridger Rd
CITY STATE ZIP
PHONE NO.
Lake Forest Ca 92630 1949.859.8466
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Formsftol spa appl (red3-04).xis 1