HomeMy WebLinkAboutS2022-0199 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
11 Rue Villars
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Existing pool and spa remodel. (3) Additional gas and electric lines added for (2) new frepits
and BBC. ESTIMATED $ VALUATION ✓ $50,000
SWIMMING POOL ❑✓
SPA 2
Check Appropriate box for Applicant
POOL FENCING ❑
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
Olson RD
ADDRESS
OWNER'S E-MAIL ADDRESS
11 Rue Villars
CITY STATE ZIP
PHONE NO.
Newport CA
949.535.6978
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
BGB Design Group Goy Art
ADDRESS
ENGINEER'S E-MAIL ADDRESS
3185 C1 Airway Ave
CITY STATE ZIP
PHONE NO.
Costa Mesa CA 92626
714.545.2898
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Pool Icons Rich Kiersnowski
479446
I No. 53 Class C
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
3920 E. Coronado St. Suite 111
Rich.Poolicons@Gmail.com
CITY STATE ZIP
PHONE NO.
Anaheim CA 92807
949.403.5478
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
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DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xis