HomeMy WebLinkAboutS2021-0227 - Permit Application"� "r WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY
BUILDING DIVISION CH �Z7 0
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
OWNER'S E-MAIL ADDRESS
LOT BLOCK
TRACT
CITY STATE Z/IP/
PHONE NO.
2.DESCRIPTION OOFWORK U\, (SCL CIU-tekJ
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ESTIMATED $ VALUATION
SWIMMING POOL ❑ SPA qP
POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRS
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ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE Z/IP/
PHONE NO.
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
Zc� iJ -- 005 w-\
CITY STATE ZIP
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PHONE NO.
5. CONTRACTOR'S NAME
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BUSINESS LICENSE
STATE LICENSE
No, O�A63lass
ADDRESS f S J`(,
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
1
PHONE NO.
9
USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).x1s
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