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HomeMy WebLinkAboutS2021-0138 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION to )� CITY OF NEWPORT BEACH BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) 1601 Ruth Ln LEGAL DESCRIPTION LOT BLOCK TRACT 2. DESCRIPTION OF WORK Pool and Spa 555 sq It with gas and electric to future bbq and firepit ESTIMATED $ VALUATION 45000 SWIMMING POOL ® SPA ® POOL FENCING ❑ DRAINAGE EZ Check ADDrODriate box for Aoolicant 3. OWNER'S NAME LAST FIRST Kohan Nick ADDRESS OWNER'S E-MAIL ADDRESS 1601 Ruth Ln CITY STATE ZIP PHONE NO. Newport Beach Ca 92660 949.303.9427 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 J3 5. CONTRACTOR'S NAME BUSINESS LICENSE STATE LICENSE Orange County Pools No. 839719 ClassC5 ADDRESS. CONTRACTOR'S E-MAIL ADDRESS 960 6th St #101A-148 CITY STATE ZIPPHONE NO. Norco Ca 92860 714.225.2907 :E VSE ONLY 0-370 PERMIT NO. SZP� VL — ©I �Z OZ -1 — 0 CU PLAN CHECK NO. Z�% r I POOL P/C FEE $ DRAINAGE P/C FEE $G Forms\Pool spa appl (rev3-04).xls