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SWIMMING POOL PERMIT APPLICATION|office Use Only #:Poot_0298-2029 im Fee:$125 _;invoice t:220Townoficc742BayRoad,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net JUN 10 2020 Taxmapiw#:O0\.\a~I=Subdivision Name:_Everoy(ee CONTACT INFORMATION: ©Applicant:, Name(s):Koterint and Matthew Authied Mailing Address,C/S/2:_12.Wel,Dive,Queensbury NY aco} Cell Phone:(518)ALO~74 G0 Land Line:_{alfaEmail__katoouthil@ yo-bvoo conn a ¢Primary Owner(s):.Name(s):___Kacthyed ing 0nd Modtien Audthiey Mailing Address,C/s/z:_13.Halen,Dive,Queensbury NY (ago Cell Phone:_(51%_)QO T4h0 land Line:_()_N/A Email _Kokeavth/@ yahoo Corn O check if all work will be performed by homeowner only *Installer/Builder:Workers’Comp documentation must be submitted with this application Contact Name(s):50 (0Qve Mecmosd Pools LLC Contractor Trade:Pool Tastotod vow Mailing Address,€/S/2:OS PBcoodwoy Ske |Fort Eawoud NY jagaé Cell Phone:_{)Nand tine:(518)JA14 710 Email:__SP(0.40€0015 @ vilook..comm **List all additional contractors on the back of this form Contact Person for Building &Code Compliance:_Mkt Brancok Cell Phone:(___)Land Line:(519)PI Fad Email:__spcaque pools @ ovilook .com ‘Swimeing Pool Packet Revised February 2019 SWIMMING POOL INFORMATION: CIRCLE ONE:ABOVE-GROUND se or Poot:_WHwx 28’. 1 MANUFACTURER:Sprague,Mermaid Pools LLC (MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): Steel/Vinyl.v Fiberglass Gunite Poured Concrete Other 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 |,or my agents,will obtain a certificate of compliance before use of the pool. Ihave read and agree to the above: PRINT NAME: SIGNATURE:DATE:ilo 402d ‘Suimmiog Pool Packet Revised February 2019,