HomeMy WebLinkAboutREV20-1282 - Permit Application' �cv20-1282
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WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
,�,� CITY OF NEWPORT BEACH REVISION
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
420 Poinsettia Ave. Permit # 0455-2020
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Provide Acrylic panels in floor of swimmna pool
ESTIMATED $ VALUATION
SWIMMING POOL FKI
SPA ❑ POOL FENCING ❑
Check Appropriate box for Applicant
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
Fadavi Ali R
ADDRESS
OWNER'S E-MAIL ADDRESS
420 Poinsettia Corona Del Mar CA 92625
CITY STATE ZIP
PHONE NO.
Corona Del Mar CA 92625
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP TONE
NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Mission Pools of Escondido
326760 C-53
No. Class
ADDRESS -
CONTRACTOR'S E-MAIL ADDRESS
22600- E Lambert #1104
CITY STATE ZIP
PHONE NO.
Lake Forest CA 92630
949-588-0100
OFFICE USE ONLY
PERMIT NO. V4
PLAN CHECK NO. b
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls