HomeMy WebLinkAboutS2021-0192 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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1. PROJECT ADDRESS
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
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SWIMMING POOL
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GLL rJl/t OY I hTIMATED $ VALUATION L4 71 6°0
SPA POOL FENCING ❑ DRAINAGE
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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n 4. ENGINEER'S NAME LAST FIRST
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LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
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5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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No. ClassS
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
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PERMIT NO. St r �(�`L J USI e D�'11 $ �i i•Oj�
PLAN CHECK NO. mwi4
POOL P/C FEE $ M46
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DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls