HomeMy WebLinkAboutS2021-0091 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2./DESCRIPTION
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SWIMMING POOL ❑ SPA POOL FENCING ❑ DRAINAGE®�
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATES
PHONE NO.
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSEq STATE LICENSE
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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ONE NO.
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PERMIT NO. �1.vtil•D4i�'10 C�I/D°LI•D��� 5192J.�Q��
PLAN CHECK NO.
POOL P/C FEE $
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DRAINAGE P/C FEE $
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