HomeMy WebLinkAboutS2019-0004 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY
BUILDING DIVISIC CH 2414 - OD04—
MrAOC MINI UK I YYC
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
L 3 (;b Qfs -, n: He
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK S?4
SPA
Check ADDroDriate box for Aoolicant
I'Z
ESTIMATED $ VALUATION
3. OWNER'S NAMELAST FIRST
\\
ADDRESSQQ
OWNER'S E-MAIL ADDRESS
F`' ���� �®
CITY ^'_' STATE ZIP
/POS `7
PHONE NO.
81 �
2 663
�'ra
4. ENGINEER'S NAME` LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
¢/ ,, I� / STATE ZIP
PHONE NO.
-
,'�N� 1h„ Ca- �2��
2P (o1m1�
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE ¢�
� (--S'
N Ow b L Class
ADDRESS '!
`�q)
t
CONTRACTOR'S E-MAIL ADDRESS
°
QIA/C� U v
CITY / STAT / ZIP
Z:SM Cc�� �2 G`7 2
IPHONENO. 72- r C
ej �j2.2-d!
r�
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
FormslPool spa appl (rev3-04).xls � /)