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04 WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
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BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
2772 BAYSHORE DR., NEWPORT BEACH
LEGAL DESCRIPTION
LOT 2 BLOCK TRACT 1014
2. DESCRIPTION OF WORK INDOOR SHOTRETE POOL - APPROX 487 SQ. FT.
ESTIMATED $ VALUATION 50.000
SWIMMING POOL EK SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check ADDroUriate box for Aoolicant
3.
OWNER'S NAME LAST
FIRST
MORIARTY KEVIN
ADDRESS
OWNER'S E-MAIL ADDRESS
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—2W9 RAYSHORE DR,
CITY STATE
ZIP
PHONE NO.
NEWPORT BEACH, CA. 92663
949.300.0310
4.
ENGINEER'S NAME LAST
FIRST
LICENSE NO.
SIMPSON & ASSOC.
S3812
ADDRESS
ENGINEER'S E-MAIL ADDRESS
23 ORCHARD ST.
CITY STATE
ZIP
PHONE NO.
LAKE FOREST, CA 92630
949.206.9929
5.
CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
DEVORE POOLS & SPAS
BT97026761
�No.401549 Clas
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
PO BOX 828
devorepoolspa@cox.net
CITY STATE
ZIP PHONE NO.
SAN JUAN CAPISTRANO CA. 92693
949.493.4374
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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Forms\Pool spa appl (rev3-04).xls 9
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