HomeMy WebLinkAboutX2019-0110 - Permit Application (2)WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT I b t M, . i l BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL
m
' t b f r A licant
ESTIMATED $ V LUATION
POOL FENCING ❑
DRAINAGE ❑
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FIR
0 3.
OWNER'S NAME
LAST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
4.
ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
&
CONTRACTOR'S NAME
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BUSINESS LICENSE STATE LICENSE
CISSSB
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
X4362
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CITY
CA-
STATE
ZIP PHONE NO.
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;E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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