HomeMy WebLinkAboutX2021-0118 - Permit Application0ak °kr WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
'� , MV": CITY OF NEWPORT BEACH
PLEASE PRINT OR TYPE BUILDING DIVISIONSZ o21 o I � g
1- PROJECT ADDRESS (NOT MAILING ADDRESS)
Francisco Dr
LOT
2. DESCRIPTION OF WORK POOI and Spa 760 Sq It
as an a eInc to LOU, Fire Pit48,000
ESTIMATED $ VALUATION
SWIMMING POOL ® SPA ® POOL FENCING ❑ DRAINAGE
Check Appropriate box for Applicant
® 3. OWNER'S NAME LAST FIRST
Guyser Jason
ADDRESS
OWNER'S E-MAIL ADDRESS
2218 Francisco Dr
CITY STATE ZIP
PHONE NO.
Newport Beach Ca 92660
949.514-5226
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
Biedenbach Chris
74003
ADDRESS
ENGINEER'SE-MAILADDRESS
1201 N. Tustin Ave
CITY STATE ZIP
PHONE NO.
Anaheim Ca 92807
714.630.6100
E] 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITE' STATE ZIP
PHONE NO.
OFFICE USE ONLY
PERMIT NO. 1
PLAN CHECK NO. C3)
Z�) C3)
POOL P/C FEE $ I
DRAINAGE P/C FEE $
FOrmslPod spa appl (MM3-04).As