HomeMy WebLinkAboutS2021-0253 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
F�¢ I* M
CITY OF NEWPORT BEACH S 7=1-0283
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
280 Evening Canyon Rd
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Pool and Spa 243 sq ft m
ESTIMATED $ VALUATION 55,000
SWIMMING POOL ® SPA ® POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
Mendell
ADDRESS
OWNER'S E-MAIL ADDRESS
280 Evening Canyon Rd
CITY STATE ZIP
PHONE NO.
Corona Del Mar Ca 92625
714.954.8474
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
Elite Custom Pools
No. 529870 classC53
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
25871 Vicar Way
CITY STATE ZIP
PHONE NO.
Lake Forest Ca 92630 1714.606.4007
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
FormslPool spa appl (rev3-04).)Us