HomeMy WebLinkAboutS2022-0206 - Permit Applicationa tnr
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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BUILDING DIVISION
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1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT
BLOCK
TRACT
2. DESCRIPTION OF WORK FOOL Ic.� �V1 O L x ( T �� II SQ t4—
C ft� —tc, iGt= P IZ ESTIMATED $ VALUATION LI 4�—k 000
SWIMMING POOL Lys SPA ®� POOL FENCING DRAINAGE 4\
Check Appropriate box for Anolicant (q�w-L
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
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4. ENGINEER'S NAME LAST FIRST
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LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
Pq/1 ~4 C I vvt C
6-50 - 6 I co
rl 5. CONTRACTOR'S NAME
B5SINEE2S��S LICENSE
STATE LICENSE
�OL S
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No./ lass
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls