HomeMy WebLinkAboutS2022-0053 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
YLCAJC YKIN I UK I YYt
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
4515 Orrington Rd
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Pool and Spa 260 sq ft
ESTIMATED $ VALUATION 50,000
SWIMMING POOL ® SPA ® POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
Ziemba Larry
ADDRESS
OWNER'S E-MAIL ADDRESS
4515 Orrington Rd
CITY STATE ZIP
PHONE NO.
Newport Beach Ca 92625
949.975.0123
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
Bret Steele
No.1231T6 Classc-r,3
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
4921 E Leeds Ave
CITY STATE ZIP
PHONE NO.
Orange Ca 92887
714.496.1427
'E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
S � - 0053
0643 � 2o2v
�T3 0 B 42.1 b2--
2z72g
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xis
'Q 20 M - 0&08