HomeMy WebLinkAboutS2020-0151 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NO NG ADDRESS)
LOT BLOCK TRACT
2. DESCRIPTION OF
SWIMMING POOL
-FopL_ C
i, / N'eelll13 ktS)TIMATED $ VALUATION
SPAX(-',�� POOL FENCING ❑
Check Appropriate box for Applicant
KvOcD
DRAINAGE
3. OWNER'S NAME LAT FIRST
ADDRESS/
OWNER'S E-MAIL ADDRESS
CSTATE J �/ / ZIP
w O
PHONENO.
n,p
S/ c7 CG / G�✓c7
4. ENG NEER'S� LAST FIRST
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LICENSE NO.
0 76
ADDRESS
ENGINEER'SE-MAIL ADDRESS
CITY STATE ZIP
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PHONE NO.
17�jv&o J
C -C/�-
5. O TRACTOR'S NAME��
( (�✓Y / /�V �'
BUSINESS LICENSE
STATE LICENSE
C.y��
No.�3( ( Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY n STATE ?IP
PHONE
ON 1 76� 5�,(U cj
OFFICE USE ONL
ERMITNOy l: L�-� R V✓��o "lJl�� y �L� �'��
PLAN CHECK NO.✓',V
POOL P/C FEE $ l ✓ "
DRAINAGE P/C FEE $
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