HomeMy WebLinkAboutS2021-0092 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPOBUILDI G DIVISION CH OV"1�
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
6 2�_
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
co i'f h �. ESTIMATED $ VALUATIO cJ d r 0 dc)
SWIMMING P00�e SPA,) -!J' POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
fat �r�f�oy�i P6
ADD SS
OWNER'S E-MAIL ADDRESS
2 e
�4Ez 13 ERiz, vII co
CI Y STATE ZIP
PHONE NO.
L) 903 `� ��(6
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
j 7! X96 c -S3
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
Z2
1�4-r4el�eR Z AA/S
CITY STATE ZIP
0 rj\l
PHONE NO.
:E USE ONLY
PERMIT NO. �Z tSl�l _ V uq V
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls