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'P oo SWIMMING POOL PERMIT APPLICATION_[office use Only Permit #: four—0D2B-2020—Hons &Qaeeaiay Permit Fee:$12_;invoice #:_ZbOY 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net Notes: Project Location:2 Sweex ld Tax Map ID #:24 bol -\"AY Subdivision Name: CONTACT INFORMATION: ©Applicant: Name(s):_a rchele.P Ras Mailing Address,C/S/Z:__/52 Sweet Rd Queenshury,ny /afeg Cell Phone:_(41 )744-3330.landline:(5)742 pk Email:Dip coss /1 @ ast ©Primary Owner(s): Name(s):chee,P.Ross Mailing Address,C/S/2:153 Sweet Ld Gyeenshun,NY /d&4p~ Cell Phone:_(Sif)744-3933.land Line:(442 )~742 "190 Email:PA p S17 CO Bal Gry Oi Check if all work will be performed by homeowner only «* Installer/Builder:Workers’Comp documentation must be submitted with this application Contact Name(s):SY rngues Mermaid Pools —Michael Brancah Contractor Trade:SA i Mo (ddl Construct ba Mailing Address,C/s/z:300 Orptidlany,Quite £fort Edhwavl,NV [2827 Cell Phone:_(5/%)307 =[p 2.J"landline:(SIR)TH7-4270 Email:SPTHOUeLDOO IS @-pt1DDIC Lom. **List all additional contractors on the back of this form Contact Person for Building &Code Compliance:__[ Cell Phone:(___)Land Line:!_C) Email HAT TON TS aT) ‘Swimming Pool Packet Revised May 2020 V7 a SWIMMING POOL INFORMATION: CIRCLE ONE:ABOVE-GROUND.IN-GROUND, \ryesizeoroot:\S iQ Kidney manuacturer:_Lyvioevial Poois MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): Steel/Vinyl 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: PRINTNAME:MichePRossSIGNATURE:“YroehibsPisapate:__e/1#/aea0 ‘Swimming Pool Packet Revised May 2020