HomeMy WebLinkAboutS2020-0187 - Permit Application"' °"r WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
0CF F.
' CITY OF NEWPORT BEACH
BUILDING DIVISION r
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
12 Burning Tree Rd
LOT
BLOCK
2. DESCRIPTION OF WORK Pool and Spa 481 sq ft
ESTIMATED $ VALUATION 45,000
SWIMMING POOL ® SPA ® POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
Burgener Adam
ADDRESS
OWNER'S E-MAIL ADDRESS
12 Burning Tree Rd
CITY STATE ZIP
PHONE NO.
Newport Beach Ca 92660
949.335.0223
0 4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
Lacher Todd
67656
ADDRESS
ENGINEER'S E-MAIL ADDRESS
1201 N Tustin Ave
CITY STATE ZIP
PHONE NO.
Anaheim Ca
1714.630.6100
® 5. CONTRACTOR'S NAME
BUSINESS LICENSE STATE LICENSE
Promontory Pools
o.404194 ClasC53
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
17401 Irvine Blvd #B
CITY STATE ZIP
PHONE NO.
Tustin Ca 92780
714.606.5710
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
FormslPool spa appl (rev3-04).)ds