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applicationBlas SWIMMING POOL PERMIT APPLICATION|office Use Only permit FOOL.DZS%-Ze20 To of Crd Permit Fee:$IZED";nvoice #2285742BayRoad,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net busy neces srces eee Project Location:4 Becru Patel be Tax Map ID #:9.1Q -1-23 ‘Subdivision Name: CONTACT INFORMATION: *Applicant: Namets):__Skeohanie Bucn: Mailing Address,C/S/Z:%Bescn Pakeh Se Queensbury DY 1axo¢ Cell Phone:_(I181_)424 o1g’s landtine:(J ) Email:__Stoaca a4 ©asail Com ©Primary Owner(s): Name(s):_Skeolhanie Bucn: Mailing Address,C/S/2:_%hercr Pateh Ne Qusomsdoum WY 1axof Cell Phone:_(“13|_)424 0133 9 Land Line:_(__)_) Email:__s\bucast3.4 ©Brat com ©check if all work will be performed by homeowner only ©Installer/Builder:Workers’Comp documentation must be submitted with this application Contact Name(s): Contractor Trade: Mailing Address,C/S/2: Cell Phone:_()Land Line:_() Email: *#List all additional contractors on the back of this form ‘Contact Person for Building &Code Compliance:b ECEIVE ci nd Line Ir 1iemie4—ft TONY ‘Swimming Pool Packet Reuse February 2018 SWIMMING POOL INFORMATION: CIRCLE ONE:\BOVE-GROUND IN-GROUND size or Poot:1%*34 manuracturer:Atlantic Chesapeake MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): Steel/Viny!Fiberglass Gunite _Poured Concrete Other _% Declaration:|acknowledge no construction activities shall be commenced prior to issuance of a valid permit.1certifythattheapplication,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:Stephan £.Bucas SIGNATURE:teh - DATE:5.2 vaca 0 ‘Swiening Poo!Packet essed February 2019,