HomeMy WebLinkAboutS2018-0214 - Permit ApplicationS P �� Gt�
4 .w° + WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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BUILDING DIVISION//��
PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
14592-1 6/fy Gf/L
LOT BLOCK TRACT
2. DESCRIPTION OF��WORK ��! V
l7A5 r79011— ESTIMATED$ VALUATIONr��
SWIMMING POOL (� SPA Pnrl FENrINr n
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3. OWNER'S NAME LAST FIRST
6 C4uio
ADDRESS
OWNER'S E-MAIL ADDRESS
+� /� ` , //' /�
�Aq Wdir G.�I�
CITY STATE ZIP
PHONE NO.
45-0 Clztoz7
Z/1/ 2-/l
4. ENGINE S NAME � LAST FIRST
f,J� AGI ro ,-\
LICENSE NO.
6- S / e
ADDRESS�" y
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ENGINEER'S E-MAIL ADDRESS
94 3 Z 'f I (moi
CITY STATE ZIP
PHONE NO.
(zvl�i fZ�e/ if
I qO '-/113.1-72—
CONTRACTOR'S NAME (
1 �C�f�J'
BUSINESS LICENSE
STATE LICENSE
No.`/c1Z`f%6 Gas3
ADDRESS ///n J/a^r�( DD���
F Cil (� 4ol ep7lo
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
�511-1 �i -6n & Cl ?7--
PHONE NO.
1 cl'i' F3o64es
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls