HomeMy WebLinkAboutS2022-0215 - Permit Application". WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION l
CITY OF NEWPORT BEACH
BUILDING DIVISION
1 PROJECT ADDRESS (NOT MAILING ADDRESS)
321 Aliso Ave
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Spa 126 sq ft w/ gas and electric for BBQ and Fire Pit
ESTIMATED $ VALUATION 30,000
SWIMMING POOL ❑ SPA ® POOL FENCING ❑ DRAINAGE EZ
Check Appropriate box for Applicant
3. OWNER'S NAME
LAST
FIRST
Clougherty
Annie
ADDRESS
OWNER'S E-MAIL ADDRESS
321 Aliso Ave
CITY
STATE
ZIP
PHONE NO.
Newport Beach
Ca
92660
714.541.0228
❑ 4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
Thompson
Matt
86051
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 Pacific Pools
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
25108 Marguerite Pkwy #A-79
CITY
STATE
ZIP
PHONE NO.
Mission Viejo
Ca
92692
949.367.9710
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
Y'
AAA
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls