HomeMy WebLinkAboutS2021-0190 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
BUILDING DIVISION Cv ZOZ�
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
1821 Santiago Or
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK New Pool and Spa 526 sq It
ESTIMATED $ VALUATION 45,000
SWIMMING POOL ® SPA ® POOL FENCING ❑ DRAINAGE
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
Housair Samira
ADDRESS
OWNER'S E-MAIL ADDRESS
1821 Santiago Dr
CITY STATE ZIP
PHONE NO.
Newport Beach Ca 92660
714.665.2108
❑ 4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
Biedenbach Chris
74003
ADDRESS
ENGINEER'S EMAIL ADDRESS
1201 N. Tustin Ave
CITY STATE ZIP
PHONE NO.
Anaheim, CA 92807
1714.630.6100
® 5. CONTRACTOR'S NAME
BUSINESS LICENSEro-
TATE LICENSE
Five Star Pools
608969 classC53
ADDRESS I /I
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CONTRACTOR'S E-MAIL ADDRESS
9146 Gardenia
CITY STATE ZIP
PHONE NO.
Fountain Valley, CA 92708
714847.4177
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (reY3-04).)ds
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