HomeMy WebLinkAboutS2021-0229 - Permit ApplicationigWyfJ .
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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PLEASE PRINT OR TYPE BUILDING DIVISION Selo e2, — �Z
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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ILEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF
SWIMMING POOL SPA
Check Appropriate box for Applicant
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ESTIMATED $ VALUATION �� 0o O
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAMELAST FIRST
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ADDRESS _j /A/-e—
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OWNER'S E-MAIL ADDRESS
CITY
CITY STATE ZIP
PHONE NO.
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E] 4. ENGINEER'S NAME LAST FIRST
LICENSE N0,
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
rl 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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No. W /(� Class -'c
ADDRESS
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CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
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OFFICE USE ONLY c ) �7
PERMIT NO. / �1 �✓ Z�
PLAN CHECK NO. ✓ C G
POOL P/C FEE $ 9
DRAINAGE P/C FEE $
Forms\Pool spa app] (rev3-04).xls