City of Coppell
Environmental Health Department
PUBLIC SWIMMING POOL/SPA PERMIT APPLICATION
P.O. Box 9478, Coppell, Texas 75019-4409 (972) 462-5177
PERMIT STATUS: (Check One) New Pool/Spa _______ Renewal _______ Change of Owner ________
NUMBER OF POOLS/SPAS _______________________________ PERMIT FEE DUE: $________________ ($200.00 per pool/spa)
POOL NAME:________________________________________________________ POOL PHONE:___________________
_______
POOL ADDRESS:
(STREET NO. & NAME) (CITY, STATE) (ZIP CODE)
EMAIL:_____________________________________________________________________________________________________
POOL OWNER OR CORPORATION NAME:_______________________________ PHONE: ________________________________
MAILING ADDRESS:
(STREET NO. & NAME) (CITY, STATE) (ZIP CODE)
POOL MANAGEMENT COMPANY (if applicable):________________________________ PHONE: ___________________________
MAILING ADDRESS:
(STREET NO. & NAME) (CITY, STATE) (ZIP CODE)
CERTIFIED POOL OPERATOR:_____________________________________________ PHONE: ________________________
DATES & HOURS OF OPERATION:
IF THE POOL/SPA IS OPEN YEAR ROUND, HOW OFTEN IS IT SERVICED? ____________________________________________
AFTER HOURS CONTACT :_____________________________________ PHONE: _______________________________
(CONTACT IN CASE OF A CLOSURE WHEN ESSENTIAL PERSONNEL ARE NOT ONSITE. (I.E. CONDOMINIUM AND HOMEOWNER ASSOCIATION POOLS)
**IMPORTANT NOTE**
A SUFFICIENT NUMBER OF LOCKS SHALL BE PROVIDED BY THE POOL OWNER IN THE EVENT ALL GATES MUST BE
LOCKED.
I attest that the information provided above is true and accurate. I agree to comply with the City of Coppell rules and
regulations and understand that failure to do so may result in revocation or suspension of the permit.
The permit is effective for one year from the date of issuance unless sooner revoked for a cause.
The permit is not transferable and the permit fees are non-refundable.
____________________________________________ _______________________________
Signature of Applicant Date
Submit application and fee to City of Coppell, Environmental Health,
P.O. Box 9478, Coppell, Texas 75019
OFFICE USE ONLY
Approved By_______________________________________________ Date of Approval__________________
Receipt No. ________ Check # ________ Amount $ ________ Received By ________ Date ____________
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