HomeMy WebLinkAboutS2021-0239 - 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 BLOCK TRACT
2. DESCRIPTION OF WORK P—Q. + I P�t 14 /l� S -�'Co. 2
ESTIMATED $ VALUATION
SWIMMING POOL ® SPA ❑/ POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
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ADDRESSNER'S
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E-MAIL ADDRESS
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CITY STATE ZIP
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PHONE—NW
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME BUSINESS LICENSE
STATE LICENSE
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A D E (S� CONTRACTOR'S
�EJ-M///AIL ADDRESS
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CITY STATE ZIP
IPHONE NO.
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PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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