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applicationSWIMMING POOL PERMIT APPLICATION Office Use Only permit t TOOL-—0!-2029peeeePermitFee:$\25>_;invoice #:2b2+742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net Project Location:sbsseadenLoDatoty Tax Map ID #:408 la=-4y Subdivision Name:&cot Mido.ECE ANTE“ll CONTACT INFORMATION:Byam[awism192020 |i°i TOWNOF name(s Pines +Oianr Ha tiiagtonMailingAddress,C/S/2:_QO Wooacdea In Cell Phone:(SIZ)Qi pO-QS4q tand a ) Email:AQustin ©hotmail Cam ©Primary Owner(s Names Rincueua +Ninos Horning tsa Mating Address,c/siz:dO Locate In Cell Phone:1%)Neo -9599 Land Line:_(—_)_—=§———— Email:ue @ WoeCam Notes: 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):(A Ove,\Sy ben Contractor Trade:_Poo!VOSiak\or Mailing Address,c/S/z:_VS \Nade Rend [athe Oy TaoCellPhone:_()land tine:_(S\$)“784-5922 email _CUOresA0cOISD1O Nua.Tr.Com **List-all additional contractors on the back of this form Contact Person for Building &Code Compliance: Cell Phone:_()Land Line:(___)- Cyprigs Rats Lorll be Loving att Aocomentasion Over, ‘Swimming Pool Packet Revised May 2020 SWIMMING POOL INFORMATION: CIRCLE ONE:ABOVE-GROUND IN-GROUND. SIZEOF POOL:_JOxXUO MANUFACTURER: MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): Steel/Vinyl XK Fiberglass Gunite Poured Concrete x Other Declara acknowledge no construction activities shall be commenced prior to issuance of a valid permit. I 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 I 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 NAM SIGNATURE: ‘Swimming Poot Packet Revised May 2020