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WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
Ti ¢ .N CITY OF NEW PORT BEACH
=- BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS) 2412 Windward Ln.
Newport Beach, CA 92660
LEGAL DESCRIPTION I
LOT BLOCK TRACT
2. DESCRIPTION OF WORK INSTALL NEW SPA, REPLUMB POOL & SPA, INSTALL LIGHT NICHE WITH LED LIGHT, SPLIT MAIN DRAIN IN POOL
REPLACE SKIMMER, REMOVE CONCRETE, INSTALL DECK DRAINS ESTIMATED$VALUATION 50,456.00
SWIMMING POOL ® SPA ® POOL FENCING ❑ DRAINAGE
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3.
OWNER'S NAME LAST
FIRST
Widera
John
ADDRESS 2412 Windward Ln.
OWNER'S E-MAIL ADDRESS
jwidera@calbox.com
CITY STATE
ZIP
PHONE NO.
NEWPORT BEACH CA
92660
714-957-8725
4.
ENGINEER'S NAME LAST
FIRST
T
LICENSE NO.
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6S
ADDRESS
ENGI IFFR'SE-MAILADDR
CITY STATE
ZIP
PHONE NO.
5.
CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
PAUL WILLIAMS
571196 C53 C61 D51
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
227 W. CARLETON AVE
.Paled, LJ;l"l 5
CITY STATE
ZIP
PHONE NO.
ORANGE CA
92867
714-423-0179
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls