HomeMy WebLinkAboutS2022-0018 - Permit Applications aba� -OX
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION as 3-S'"'""' Ave,
CITY OF NEWPORT BEACHn6
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
223 Jasmine Ave
LOT
BLOCK
TRACT
2. DESCRIPTION OF WORK Spa 45 sq ft w/ gas and electric to bbq, (furure) fireplace and fire pit
ESTIMATED $ VALUATION 30,000
SWIMMING POOL ❑ SPA ® POOL FENCING ❑ DRAINAGE 0
Check Annronriate box for Annlicant
3. OWNER'S NAME LAST FIRST
Brinton
ADDRESS
OWNER'S E-MAIL ADDRESS
223 Jasmine Ave
CITY STATE ZIP
PHONE NO.
Corona Del Mar Ca 92625
714.788.6642
❑ 4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
Biedenbach Chris
74003
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 -
Mitch Parks
No. 838091 Clas
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
1400 S Sunkist St #190
CITY STATE ZIP
PHONE NO.
Anaheim Ca 92806
1949.228.1953
'E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
SU2-L-opt$ F/toz-rott �V20ZZ-cm
D(`�' 'U2y
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xis
151 0-