HomeMy WebLinkAboutS2021-0139 - Permit Application�wwrp "-
1;� i WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH n n
BUILDING DIVISION 9202141/
rL 0= rrJN 1 UK 1 Trt
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
1853 Port Sheffield Place
LEGAL DESCRIPTION
LOT
BLOCK
2. DESCRIPTION OF WORK Spa 72 Sq ft
SWIMMING POOL ❑ SPA
Check Appropriate box for Applicant
TRACT
_ ESTIMATED $ VALUATION 20000
POOL FENCING ❑ DRAINAGE ❑
❑ 3. OWNER'S NAME LAST FIRST
Frazier
ADDRESS
OWNER'S E-MAIL ADDRESS
1853 Port Sheffield Place
CITY STATE ZIP
PHONE NO.
Newport Beach Ca 92660
949.558.6473
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
Promontory Pools
No 404194 Class rS
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
17401 Irvine Blvd #B
CITY STATE ZIP
PHONE NO.
Tustin Ca 92780 1714.508.0557
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).)ds 92,�-C.JD3 / Lf
ma() 432H?