HomeMy WebLinkAboutS2018-0098 - Permit Application6-� S_ S 2- SZ/jv
�fiE"P °� WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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BUILDING DIVISION s201� off` b
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK fu 4.� (j6 a/L G
S t. �t ESTIMATED $ VALUATIONA6 o a u
SWIMMING POOL SPA W POOL FENCING ❑ DRAINAGE ❑
Check Aoorooriate box for Aoolicant
3. OWNER'S NAMELAST FIRST
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ADDDRES�Sp
OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS ��f �� �✓�%G �155Y (
ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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5. CONTRACTOR'S NAME CcA3
BUSINESS LICENSE
STATE LICENSE
No. -J5 Class
ADDRESS ` V,2
CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP ,PHONEAo.
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:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls