The URL can be used to link to this page

applicationSWIMMING POOL PERMIT APPLICATION Office Use Only Permit;POOL.+0 &*4.-Y9>a?Permit Fee:$V2";invoice #:2'e 2b742BayRoad,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net Notes: Project Location:Jerome pve Tax Map ID #:__O02 -3-4o Subdivisi Insallakion scvduled 8” CONTACT INFORMATION:blr2 \po20 ©Applicant: Name(s):Phat ew CAamreect Mailing Address,C/S/Z:_@ Je@ome ~ve QueensAvey Al 12804 Cell Phone:_(siv__)79/-32%landline:_(s7¥__)37¢-$2/%-(DayTime) Email:_aqamebellO yhnaloy «Corr ¢Primary Owner(s): Name(s):Serta CAMPBELL TRhey CAM fpere Mailing Address,C/S/Z:_£ JeRone Ay Oubinssury WY /2 904 Cell Phone:_(7¥_)77/-9275"land Line:_(S/¢_)¥78~-52/¢Dayrme) Email:SAme AS BOVE ©Installer/Builder: Business Name:feu,(rnContactName(s): Mailing Address,C/S/Z: Cell Phone:_()Land Line:_() Email: Contact Person for Building &Code Compliance:_747Hzs CraBeree Cell Phone:_(Sy¥__)_79/-#2 ¢5s~Land Line:(5275)378-S273 Email:=ABOVE Town of Queensbury Building &Code Enforcement Revised December 2018, SWIMMING POOL INFORMATION: CIRCLE ONE:Canove-GROUND IN-GROUND SIZE OF POOL:24 MANUFACTURER:_/2QUAjienpER FT VFLUENCE MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): Fiberglass Gunite Poured Concrete Other _K SywfleyResw Declaration:|acknowledge no construction activities shall be commenced prior to issuance of a valid permit.|certify that the application,plans and supporting materials are a true and complete statement/description of the work proposed,that all work will be performed in accordance with the NYS Building Codes,local building laws and ordinances and in conformance with local zoning regulations.|acknowledge that |have read the application and plot plan requirements and I,or my agents,will obtain a certificate of compliance before use of the pool. Steel/Vinyl Ihave read and agree to the above: PRINTNAME:MATHEW)Crm Bere sienature:pte CLL pate:do /Q}2020 ‘Town of Queensbury Bulldng &Code Enforcement Revised December 2018