HomeMy WebLinkAboutS2021-0257 - Permit Application"kr WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
$` CITY OF NEWPORT BEACH SZo2�- OZr-
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
219 Evenina Star Ln
LOT
3110140
2. DESCRIPTION OF WORK Pool and Spa 750 sq ft
TRACT
ESTIMATED $
SWIMMING POOL ® SPA ® POOL FENCING ❑
Check Appropriate box for Applicant
❑ 3. OWNER'S NAME LAST FIRST
Jones
ADDRESS
OWNER'S E-MAIL ADDRESS
219 Evening Star Ln
CITY STATE ZIP
PHONE NO.
Newport Beach Ca 92660
714.541.2009
❑ 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 92807
1714.630.6100
® 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Aqua Scapes Pools and Spas
No. Class C5
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
321 Calle Felicidad
CITY STATE ZIP
PHONE NO.
San Clemente Ca 92672- 1949.295.4611
;E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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