HomeMy WebLinkAboutS2022-0025 - Permit Application`"" " WORKSHEET 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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LOT
2. DESCRIPTION OF WORK
SWIMMING P09219�_
BLOCK
Check Aoorooriate box for Applicant
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11:73441
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ESTIMATED $ VALUATION 67` ^V— —e
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STAAT(E LICIE�NSE /
No. 1���` / Class(Y9
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
tCITISTATE ZIP
Il
PHONE NO.
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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