HomeMy WebLinkAboutS2021-0017 - Permit Applicationt;2o2t
""' WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
Ca�1�
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
I 1. PROJECT ADDRESS (NOT MAILING ADDRESS)
1331 Antigua Way
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL
Tire pit 40,000
ESTIMATED $VALUATION
SPA POOL FENCING ❑ DRAINAGE
Check Awroariate box for ADDIICant
3. OWNER'S NAME LAST FIRST
TA Partners
ADDRESS
OWNER'S E-MAIL ADDRESS
1331 Antigua Way
CITY STATE ZIP
PHONE NO.
Newport Beach Ca 92660
949.395.5055
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
Biedenbach Chris
74003
ADDRESS
ENGINEER'S E-MAIL ADDRESS
1201 N. Tustin Ave
CITY STATE ZIP
PHONE NO.
Anaheim Ca 92807
714.630.6100
® 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Blue Fountain Pools
No. Class C5
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 $