HomeMy WebLinkAboutS2023-0191 - Permit Application"" ""r° WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
*r CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
539 TUSTIN AVE. I%i�•
LOT
TRACT
2. DESCRIPTION of WORK REMOVE AND REPLACE PLASTERING ON EXISTING POOL
ESTIMATED $ VALUATION1 5,000
SWIMMING POOL ® SPA ® POOL FENCING ❑
Check Appropriate box for Applicant
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
NUEFELD , MIKE
ADDRESS
OWNER'S E-MAIL ADDRESS
539 TUSTIN AVE.
GASLAMPMIKE@HOTMAIL.COM
CITY STATE ZIP
PHONE NO.
NEWPORT BEACH, CA 92663
714-420-4699
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ZHANG,YAO
74572
ADDRESS
ENGINEER'S E-MAIL ADDRESS
3400 IRVINE AVE. STE. 105
INFO@UNIVERSALENG.NET
CITY STATE ZIP
PHONE NO.
NEWPORT BEACH, CA 92660
949-490-4240
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
OWNER BUILDER
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
1
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.%/a2
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).As