HomeMy WebLinkAboutS2017-0175 - Permit Application0¢t wP WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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BUILDING DIVISK ' u
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
/,DD7 ll
LEGAL DESCRIPTION
LOT BLOCK TRACT
2-D S IIJPTIO OF WORK AJ (4-0cj o� iv.
// , ESTIMATED $ VALUATION ICJ
SWIMMING POOL ❑ SPA POOL FENCING ❑ DRAINAGE ❑
Check Aaaroariate box for owicant
3. OWN R'S NAME
LAST
FIRST
el 47
C�50
' V
ADDRESS
OWNER'S E-MAIL ADDRESS
46
zIA
T Q
CITY
STATE
ZIP
PHONE NO.
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N
4. ENGINEER'S NAME
LAST
C
FIRS
LICENSE NO.
s
ADDRESS
ENGINEER'S E-MAIL ADDRESS
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C
STATE
ZIP
PHONE NO.
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7111-G30
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5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
V
Qj
No.ZZe423CIass
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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J�U Q 1�C 0
LO/L
CITY 1 /f .5
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STATE
ZIP
PHON NO.
OFFICE USE ONLY !,
PERMIT NO. � 2V to C)I-a':3
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls