HomeMy WebLinkAboutS2022-0105 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
2018 Nautilus Ln
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Pool and
240 sq ft and Gas to Fire pit
ESTIMATED $ VALUATION 26,000
SWIMMING POOL ® SPA ® POOL FENCING ❑ DRAINAGE EZ
Check Appropriate box for Aaalicant
3. OWNER'S NAME LAST FIRST
Ekedal
ADDRESS
OWNER'S E-MAIL ADDRESS
2018 Nautilus Ln
CITY STATE ZIP
PHONE NO.
Newport Beach Ca 92660
714.654.3201
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
Lacher Todd
67656
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
Elite Custom Pools
114629870 Clas
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
25871 Vicar Way
CITY STATE ZIP
PHONE NO.
Lake Forest Ca 92630
1714.606.4007
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).)ds