HomeMy WebLinkAboutS2022-0120 - Permit ApplicationCOO
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
1221 BerkshireLn
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Spa 50 sq ft - gas and electric to BBQ and fire pit
ESTIMATED $ VALUATION 22,000
SWIMMING POOL ❑ SPA ® POOL FENCING ❑ DRAINAGE ❑
Check Aoorooriate box for Aoolicant
3. OWNER'S NAME FIRST
Phan Phouc
ADDRESS
OWNER'S E-MAIL ADDRESS
1221 BerkshireLn
CITY STATE ZIP
PHONE NO.
Newport Beach Ca 92660
714.478.7334
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
1714.630.6100
® 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Altera Landscape
iNo.893827 Class C5
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
34145 PCH #172
CITY STATE ZIP IPHONE
NO.
Dana Point Ca 92629
866.872.2611
'E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xis