HomeMy WebLinkAboutS2021-0030 - Permit Application4" WORKSHEET FOR POOL COMBINATION PERM T APPLICATION
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BUILDING DIVISION
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1. PROJECTADDRESS (NOTMAILINGADDRESS)��
183 Camation Unit 3
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Spa 45 sq It (inside previosuly approved slab)
ESTIMATED $ VALUATION 20,Q00
SWIMMING POOL ❑ SPA ® POOL FENCING ❑ DRAINAGE ❑
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3. OWNER'S NAME LAST FIRST
Purcell Michael
ADDRESS
OWNER'S E-MAIL ADDRESS
183 Camation Unit 3
CITY STATE ZIP
PHONE NO.
Corona Del Mar Ca 92625
714.552.3021
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
Lacher Todd
67656
ADDRESS
ENGINEERS EMAIL ADDRESS
1201 N. Tustin Ave
CITY STATE ZIP
PHONE NO.
Anaheim Ca 92807
714.630.6100
® 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Elite Custom Pools
o. 529870 clay
ADDRESS
CONTRACTOR'S EMAIL ADDRESS
.25871 Vicar Way
CITY STATE ZIP
PHONE NO.
Lake Forest Ca 92630
714.606.4007
OFFICE USE ONLY
PERMIT NO. ���/ •W o J
PLAN CHECK NO. �J[/� �'� Vol_
POOL PIC FEE $
DRAINAGE PIC FEE $
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