HomeMy WebLinkAboutS2020-0132 - Permit Application (2)PLEASE PRINT OR TYPE
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION�_O'
CITY OF NEWPORT BEACH
BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
12 Vernon
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIP,4ION OF WORK Pool and Spa 224 Sq it
Gas to Firepit ESTIMATED $ VALUATION 32,000
SWIMMING POOL ® SPA POOL FENCING ❑ DRAINAGE
Check Appropriate box for Applicant
❑ 3. OWNER'S NAME LAST FIRST
Gilboa Jason
ADDRESS
OWNER'S E-MAIL ADDRESS
12 Vernon
CITY STATE ZIP
PHONE NO.
92657
Newport Coast Ca
949.336.0289
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
Todd
Lacher
67656
ADDRESS
ENGINEER'S E-MAIL ADDRESS
1201 N. Tustin
CITY STATE ZIP
PHONE NO.
Ca 92807
1714.630.6100
Anaheim
® 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Dreamscapes by MGR
No. 694588 CIasEC53
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
1901 Newport Blvd #350
CITY STATE ZIP
PHONE NO.
Costa Mesa Ca 92627 1949.608.1726
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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