HomeMy WebLinkAboutS2021-0082 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
F. �1
CITY OF NEWPORT BEACH
BUILDING DIVISION SM2,1.
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
1017 Sandcastle Dr
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Pool and Spa 390 sq ft
ESTIMATED $ VALUATION 42,000
SWIMMING POOL ® SPA ® POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
0 3. OWNER'S NAME LAT FIRST
Pedersen
ADDRESS
OWNER'S E-MAIL ADDRESS
1017 Sandcastle Dr
CITY STATE ZIP
PHONE NO.
Corona Del Mar Ca 92625
949.683.5090
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 Ca92807
714.630.6100
® 5. CONTRACTOR'S NAME
BUS ESS LIC SE
STATE LICENSE
California Pools
I
No. 1054738 ClassCS
ADDRESS
CON IL ADDRESS
438 N. EI Camino Real
CITY STATE ZIP TPHONE
NO.
San Clemente Ca 92672
949.378.6308
:E USE ONLY
PERMIT NO. 52n21 -bv$l---
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Fortes\Pool spa appl (rev3-04).xls