HomeMy WebLinkAboutS2022-0142 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATIO
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
10 Baffin Bay
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Spa - 80 sq ft gas to Fire Pit
ESTIMATED $ VALUATION 28,000
SWIMMING POOL ❑ SPA ® POOL FENCING ❑ DRAINAGE EZ
Check Appropriate box for Applicant
❑ 3. OWNER'S NAME LAST FIRST
Glatch Trey
ADDRESS
OWNER'S E-MAIL ADDRESS
10 Baffin Bay
CITY STATE ZIP
PHONE NO.
Newport Coast Ca 92657
702.985.8851
❑ 4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
Thompson Matt
86051
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
Teserra
No.656128 ClassC53
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
PO Box 1280
CITY STATE ZIP
IPHONE NO.
Coachella Ca 92236
1760.389.9222
:E USE ONLY S 'Wlr Z O 1 Z
PERMIT NO. P1 Q1 qs
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).rtls