HomeMy WebLinkAboutS2020-0010 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
OF
CITY UILDING DIVISION Chi `'�`V Not D
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
P r Iva
LEGAL DES RIP ION O
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Yob
ESTIMATED $ VALUATION r'
z
SWIMMING POOL SPA �] POOL FENCING ❑ C?� DRAINAGE
, ,Check Appropriate box for Applicant
10 3. OWNER'S NAMELAST FIRST
C 6v �� C
ADDRESS
If'2-5 LY& �oe d
O NER'S E-MAIL ADDRESS r
41*6, �bo,Cb
CITY ply STATE / ZIP
o bro
PHHfO�N%EE NO. q
4. ENGINEER'S NAME LAST FIRST
P06 / 'q-ee
LICEN E N0.
C,'
I - o[e Icy
ADDRESS
l 2 6/ /V,hiw, .
ENGINEER'S E-MAIL ADDRESS`
CITY STATE ZIP
-7
PHONE NO.
09 -6W- %lam'
rl 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
=ICE USE ONLY
PERMIT NO. 0 ,�/ o
PLAN CHECK NO. '2-071D J0
POOL P/C FEE $ CIO(�
- DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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