HomeMy WebLinkAboutS2021-0131 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
1901 Kings Rd
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK POOL and Spa replaster/retile 230 sq ft
ESTIMATED $ VALUATION 13000
SWIMMING POOL ® SPA POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
0 3. OWNER'S NAME LAST FIRST
Valle
ADDRESS
OWNER'S E-MAIL ADDRESS
1901 Kings Rd
CITY STATE ZIP
PHONE NO.
Newport Beach Ca 92663
949.222.0495
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS -
CITY STATE ZIP
PHONE NO.
® 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Mirage Landscape
No ClassC53
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
61 Three Vines
CITY STATE ZIP
PHONE NO.
Ladera Ranch Ca 92694
949,293.2800
CE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
FomisWoof spa appl (rev3-04).)ds