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F "°'"""" WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION SZ�?�
PLEASE PRINT OR TYPE
1. PROJECT ADURE55 (NOT
10 Night Sky
TRACT
2. DESCRIPTION OF WORK Pool and Spa 789 sq It
ESTIMATED $ VALUATION 75,000
SWIMMING POOL ® SPA ® POOL FENCING ❑ DRAINAGE
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3. OWNER'S NAME LAST I sT
Itri Mark
ADDRESS
OWNER'S E-MAIL ADDRESS
10 Night Sky
CITY STATE ZIP
PHONE NO.
Ca 92657
Newport Coast
714.331.9860
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
Lacher Todd
67656
ADDRESS
ENGINEER'S E-MAILADDRESS
1201 N Tustin
CITY STATE ZIP
PHONE NO.
Anaheim Ca 92807
1714.630.6100
i CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Bret Steele (Steele Pools)
No. 923975 clasC53
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
4921 E. Leeds
CITY STATE ZIP
PHONE NO.
Orange Ca 92867
1714.496.1427
: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