applicationSWIMMING POOL PERMIT APPLICATION
Office
Use
Only
Permit #:_POO L.=<
Rene err Permit Fee:$125
__;
Invoice #:
‘742 Bay Road,Queensbury,NY 12804
:518-761-8256.wavw.aueensburynet Notes:
Project Location:(0Glen
Court,
Queen
bury
TaxMapio#:305 5 -/-23 Subdivision Name:[Nt Glen.
CONTACT INFORMATION:
Name(s):10.
Mailing Address,C/5/2:1D
Cell Phone:_(512)7q/-@F43 land Line:_()
Email:ee Gl L-
Name(s TAMMC)e Carttin MNamee
Mailing Address,C/S/2:_/O ayien Couvt er WY:(2F04
Cell Phone:_(517_)79/-@d4>landtine:(774)29@ -39/.
Email:_jy L-
Sanes cel
O Check if all work will be performed by homeowner only
+Installer/Builder:wellenei,eeneaiian must be submitted with this application
Contact Name(s):_DAv
Contractor Trade:Bilepee PerltaaeeMallingAddress,C/s/z:15MaiStreetQucenSlouar,(Y-(2907
Cell Phone:_()Land Line:_|
Emailftl US @ Vanoo.nr+*[ist all additional contractors on the back of this form
Contact Person for Building &Code Compliance:
Gell Phone:_()Land Line:(___).
‘Swimming Pool Packet Revised February 2019
a4
SWIMMING POOL INFORMATION:
CIRCLE ONE:ABOVE-GROUND IN-GROUND=se oF Poot:1S Xo
MANUFACTURER:_)(V)CY ad Pore
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:
ee James MeNameepetaava.LiMeLa,Bits 5 [tt]2020
PRINT NAMI
‘SIGNATURE:
‘wring Poo Packet Revised Febroary 2019