HomeMy WebLinkAboutX2021-0082 - Permit ApplicationaWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION SMS JZ oQg7
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 Anolicant
0 3. OWNER'S NAME LAST FIRST
Pedersen
ADDRESS
OWNER'S E-MAIL ADDRESS
1017 Sandcastle Dr
CITY STATE ZIP
PHONE NO.
Corona Dei 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 Ca 92807
714.630.6100
® 5. CONTRACTOR'S NAME
BUS ESS LIC SE
STATE LICENSE
California Pools
No. 1054738 ClassC
ADDRESS
CON IL ADDRESS
438 N. EI Camino Real
CITY STATE ZIP
PHONE NO.
San Clemente Ca 92672
949.378.6308
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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