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SWIMMING POOL PERMIT APPLICATION Office Use Only, permit:FOOL-D2 b >-2029) Hone ety Permit Fee:$_|2 =5 Invoice #:& 742 Bay Road,Queensbury,NY 12808 P:518-761-8256 www.queensbury.net Notes: Project Location:(67 Aide Dowd Qeensbery vy CONTACT INFORMATIOI ©Applicant: Name(s):Aebecccr Lee Mailing Address,C/S/Z:15711 Dudee Doced Queensiasry,WY a0CellPhone:(Si)B2\-Bah land Line:(Six)A82-Oss2 Email:bree theponcon bec bs ©concerts cc ©Primary Owner(s): Name(s):hebeccee Lee Mailing Address,C/S/Z:1571 Qulae Dd Queento ve LW SOU Cell Phone:(Si¥_)DQiaaia landline:(9 ls )283-ors 2 Email:poclhewucas becky 2 pgncetl Cory 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):Lichaes 3.G un Contractor Trade: Mailing Address,C/S/Z:Upstate EnteconseS 1004 Lacs G Ad,GreenGeld Center Cell Phone:(Sig )GAS7TI5G Land Line:_()WY 1ae3 Email: **List all additional contractors on the back of this form Contact Person for Building &Code Compliance:Aebears Le € Cell Phone:(56 _)391-321 Land Line:(Si _)_293-0%S D Email:poche Uonlaerioce ©m ‘Swimming Pool Packet Revised May 2020 Ta’SWIMMING POOL INFORMATIO! CIRCLE ONE:(ABOVE-GROUND IN-GROUND sizeorPOoL:2H!hand ,(94"ooo MANUFACTURER:oe MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): Steel/Vinyl_V Fiberglass Gunite Poured Concrete other / SyrSlex Resin 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: DATE:@fH[aO ‘Swimming Pool Packet Revised May 2020