HomeMy WebLinkAboutS2021-0107 - Permit Application6""ak WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS) C
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LEGAL DESCRIPTION
LOT BLOCK TRACT
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2. DESCRIPTI NOF WORK Q �h ( Y _ -PS
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ESTIMATED $ VALUATION
SWIMMING POOL SPA \X POOL FENCING ❑ DRAINAGE ❑
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3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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��CIITY STATE ZIP
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PHONE NO.
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS INTEERS E-MAIL ADDRESS
C\I/T�Y STATE ZIP
PHH�ONE NO.
1
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5. CONTRACTOR'S AME C r�1 S �� the
BUSINESS LICENSE
STATE, LICENSE
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ADDRESS 1' `1
CONTRACTOR'SE-MAILA DRESS
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CIaTY �rrw �h� STATE ZIP
PHDNENO'i�y-l/76 a3�
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:E USE ONLY c
PERMIT NO. Z U�1 ' C)
PLAN CHECK NO. Dot 1.6-5 26 1/1��
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POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls