HomeMy WebLinkAboutS2019-0023 - Permit Application�� "° 8, WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
"�"t*" BUILDING DIVISION coum,002S
YLtAJt YKIN I UK 171'C
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LOT BLOCK TRACT
2. DESCRIPTION OF WORK 5PA- 4c
6¢A-9 T. .`L C`I'; 2g '?,f'S ESTIMATED $ VALUATION .0 0
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I] 3. OWNE 'S AME LAST FIRST
2:1 SSS Se _ MA -i2-4 —
ADDRES�Sn
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
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4. ENGINE R'S��NA^^M,,E LAST FIRST
LICENSE NO.
ENGINEER'S E-MAIL ADDRESS
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l�( K. .
CITY STATE ZIP
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PHONE NO.
Fj 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
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PHONE NO.
3736
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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