HomeMy WebLinkAboutX2021-3422 - Permit ApplicationOSG
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH 2n 2 n
BUILDING DIVISION WZ'� 7� v
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
32 Twilight Bluff
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Pool and Spa 195 Sq Ft, Demo ex. Spa, Gas to Firepit
ESTIMATED $ VALUATION 48,000
SWIMMING POOL ® SPA ® POOL FENCING ❑ DRAINAGE
Check Anoroariate box for Aoolicant
❑ 3. OWNER'S NAME LAST FIRST
Kashani Hamid
ADDRESS
OWNER'S E-MAIL ADDRESS
32 Twilight Bluff
CITY STATE ZIP
PHONE NO.
Newport Coast Ca 92657
949.413.4940
❑ 4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
Lacher Todd
67656
ADDRESS
ENGINEER'S E-MAIL ADDRESS
1201 N. Tustin Ave
CITY STATE ZIP
PHONE NO.
Anaheim Ca 92807
1714.630.6100
® 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Blue Fountain Pools
No. 1004554 ClassC53
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
1151 S Grand Ave
CITY STATE ZIP
PHONE NO.
Glendora Ca 91740 1626.335.0006
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa app] (rev3-04).xis