HomeMy WebLinkAboutS2022-0006 - Permit Application" WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
1530 Anita Ln
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Pool and Spa 450 sq ft
SWIMMING POOL ® SPA EZ
Check Appropriate box for Applicant
ESTIMATED $ VALUATION 40,000
POOL FENCING ❑ DRAINAGE ❑
❑ 3. OWNER'S NAME LAST FIRST
De Carrier John
ADDRESS
OWNER'S E-MAIL ADDRESS
1530 Anita Ln
CITY STATE ZIP
PHONE NO.
Newport Beach Ca 92660
773.961.8453
❑ 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
1714.630.6100
® 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Montesantos Builders
No.1077463 ClassB
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
1530 Anita Ln
CITY STATE ZIP
PHONE NO.
Newport Beach Ca 92660
630.514.5158
OFFICE USE ONLY n / �y
PERMIT NO. � / z ava
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).As