HomeMy WebLinkAboutX2021-0386 - Permit Applicationu r � WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION _
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BUILDING DIVISION XZ0ZI-'0 g(0
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1:. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK L v/G�
i�1Y4 t� ESTIMATED $ V LUF
SWIMMING POOL ❑ SPA ❑ POOL FENCING
Check Appropriate box for Applicant
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DRAINAGE
3. OWNER'S NAME. LAT FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHPNE NO.
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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5. CONTRACTOR'S NAME
BUSINESS LICENSE STATE LICENSE
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No. ClassC'
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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STATE nn ZIP
CITY60-04
PHH5NE NO.
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
rormswooi spa apps (rev3-u4).xls.