HomeMy WebLinkAboutS2021-0188 - Permit ApplicationNewr rk'' WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
BUILDING DIVISIO
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS) 2
1720 Kings Rd
LOT
BLOCK
2. DESCRIPTION OF WORK Pool and Spa 455 sq It
ESTIMATED $ VALUATION 30000
SWIMMING POOL ® SPA V , POOL FENCING ❑ DRAINAGE ❑
Check Aparooriate box for Annlicant
3. OWNER'S NAME LAST FIRST
Werner Eric
ADDRESS
OWNER'S E-MAIL ADDRESS
1720 Kings Rd
CITY STATE ZIP
PHONE NO.
Newport Beach Ca 92660
949.244.0750
0 4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
Lacher Todd
67656
ADDRESS
ENGINEER'S E-MAIL ADDRESS
1201 N Tustin Ave
CITE' STATE ZIP
PHONE NO.
Anaheim Ca 928 07
1714.630.6100
® 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Promontory Pools
No. 419 CIassC53
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
17401 Irvine Blvd #B
CITE' STATE ZIP
PHONE NO.
Tustin Ca 92780
714.508.0557
;E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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