HomeMy WebLinkAboutS2021-0194 - Permit Application (2)a WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
,. CITY OF NEWPORT BEACH C �� (G> `1
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
22 Shoreridge
LEGAL DESCRIPTION
LOT BLOCK
TRACT
2. DESCRIPTION OF WORK Pool and Spa 464 Sq Ft
ESTIMATED $ VALUATION 45,000
SWIMMING POOL ® SPA ® POOL FENCING ❑ DRAINAGE
EZ
Check Awronriate box for Annlicant
3. OWNER'S NAME
LAST
FIRST
Woodgrift
Randy
ADDRESS
OWNER'S E-MAIL ADDRESS
22 Shoreridge
CITY
STATE
ZIP PHONE NO.
Newport Beach
Ca
92657
0 4. ENGINEER'S NAME
LAsr
949.299.8021
FIRsr
LICENSE NO.
Biedenbach
Chris
74003
.ADDRESS
ENGINEER'S EMAIL ADDRESS
1201 N_ Tustin Ave
CITY
STATE
ZIP PHONE NO.
Anaheim
Ca
92807 714.630.6100
® 5. CONTRACTOR'S NAME
BUSINESS LICENSE STATE LICENSE
Bret Steele
ADDRESS
No. 923975 cfas 5
CONTRACTOR'S E-MAIL ADDRESS
4921 E. Leeds Ave
CITY
STATE
ZIP
PHONE NO.
Orange
Ca
92867
714.496.1427
-E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls