|
:
<br /> . : . f'—"��.. � - - 6ufldfng Department , '
<br /> !. .
<br /> Date Receiue,d�, �� � � Phone Con,tact fos Permitting '$.�,� �$7�_. �. . �3 Z.6
<br /> /� _��) ,
<br /> Qwner's Name C9 � t9 Cl�� �Q w+.1G�• Owner Phone Number .��_� �� t{��+„� .
<br /> ., � . .. •. .—.�
<br /> Owner's Address � � �d`a-S .-'t" �-'"�~ ' Uwner Phone Nami�ec�^
<br /> i .
<br /> Fee Simple Titieholder Name �- ` Owner Phone Nutriber
<br /> . ' • ' � .
<br /> Fee SimpieTiflehotder Addiess"` i � . .
<br /> Jfl8 ADDFiESS I 1 . . ' � . ' LO'F�� �.� .
<br /> � � . ' . , � � .
<br /> 5UBDNISION. ' ���� t` 'rC!s,�C r'G� < PARCEL.ID# jZ�-� a-i �� C3 C�� ' �
<br /> � � " ' • {08TAiN�Ei FBQM PltOPEtt'iY TAX NOTlGE) •
<br /> WdRK PROPOSED ' , ' NEW GONSTR ADDlAl..T C] St�N CJ MOVE CJ I7EMOLISIi , .
<br /> ' _ B ( {tdSTAl1 � REPAIR . .
<br /> FFtOPt}SED USE . Q � SFR , ' �- COtu1M 'Q OTHEF2 . ,
<br /> TYPE O�CON5TRUCTlOf+i Q � Si.00EC � FE2AME � Q � STEEL � QTNER —I
<br /> DESCRIPTION OP WfORK, � Cr��u1 wt ,c.�-'c' - �C�C►r'.�� )C 7." S"�-f- -, /`��l�..1•�I, —s`'"—
<br /> BUiLD1N�i SiZE " i SQ FOOTAGE�—�] ' 1i�tGHT �,_,____�
<br /> BUILDING $.. ' ' ��,� - ' ' _
<br /> �.. �.�-��S. '�'' VALUAI'{ON tJF TOTI�t.CC1AlSi"RtlCTlOfV . • - � •
<br /> �"`7""_" - - -
<br /> Q ELECTRICAL $ • AMP SERVICE Q PROGF2ESS�ENERGY Q W,R.E.C.
<br /> - . � _ ._.____� - .
<br /> C] PUJMBIfVG ' '$ I �"� � . � .
<br /> �' �4 .
<br /> Q MECHA►�l_ICAL $ ; � ; ' - � � ' VqLUATiON.OF MECHANiCAL iiVST�ILLATtOtd �,�
<br /> � �
<br /> Q ., GAS r., , � �, ROO�ING- �Q . SPECiALTY � 'OTFIEF2- , � • .
<br /> FINISHED F40QR ELEVAT ONS � � FLQOD ZD{UE AREA , QYES' QNO '
<br /> • � .. , ,
<br /> i . _
<br /> BUIL.DER � - �i� COMPANY � `Gr`St`G�7�( d r ,SC f"i1 r`G�
<br /> SIGNATURE I ' ��isi�iz� Y N � '�cUR�rsr Y�!N '
<br /> Address 7� ' u � /U 4!/e�" ' �3 rG - . � . '. License# ,��^ �
<br /> . � , ,>z
<br /> ��E�T�rcuv�.' ` � . � ��°co�u�nr�nr . , . .
<br /> S1�GNATI'iRE REt',IS7ERED ' .Y l Id : '�F�E CURRENT - Y/N �
<br /> Addres� - � ' � � � License# � ' - �
<br /> �
<br /> i ,
<br /> PLUMBER "' i ` '� .. � r COMPANY '
<br /> SiGNATURE � � � ��is,c�tz�p Y/ N E�E CuRRFtiT ' ,Y!N
<br /> Address � �� "� License# �� ��
<br /> MECEiANiCAL , . . , � , . ' COMFA[+!Y
<br /> • SIGNATURE • � � REGIS7'EREq Y/ N , FEE CURREN7 ' Y/N . ' .
<br /> Address � . . ' . License# � �
<br /> � t . •. � , � � • .
<br /> .�. �-OTFIEK" . • _. _.,_. _.:_.__ ' ._ y • • - .
<br /> SIGNA7'URE ..._�_,.. _.i.. ttEGIS7ERED � Y I N FEE C[1RRENT � • _____
<br /> Address ' • ' ' • � . LiCerise�k � ...L �
<br /> RESIDENTIAL Attac�(2)Pla Plans;(2)se#s of Buifding Plans,(1)set of�nerg'y Forms;R 0=W�Permit�for new constructlon,
<br /> , , 'Mlnirnum,ten. ,0)working days aRer submittat date. Required onsite,ConstrucUon P{ans,Stasmwater Ptans wl Sil�Fence instailed,
<br /> r� •� Sanitary.Faclti �es 8�"{:dumps;er;Stt+s Worlc Peanit fo�subdivlsic�r+sflaige proJecfs�
<br /> -.C�MN!�6�CIAl: ,. _,Attac�ti.{3)_ca Qlete sets of�uildl�g�Plans p1US�'Llfe Safety Page,.(1)set•oF Energy Forms.R-O-W Permit for new constructlon.
<br /> �Mfiiij�um ten �70)wodting day's aftersuBmittai date. Require�3bnsite,`Construcuan-Ftaris;SYnrmwrat��r ta:►�wt'St;t���r,e-:n��,lis�,
<br /> � Sani�-ary Faclt.ties S 1 dumpsier.Site Work Permit for a!{new proJects.A!1 commercial requirements tntSSt meet icomptiance
<br /> ' SIGN PERMlT Attach(2)se�of Engineered F?la�s. ,
<br /> '"`*P�tOPER'tY SURVEY requlred,for all NEI1.U.construction. • � • .
<br /> Directians: � � � � � �
<br /> �ill out applicafion co�pletely. • ' ' • -- . .
<br /> OWner 8�CanUactnT�ign b�cliio�f applicaGan,notasized � - , ,
<br /> if over�254D,a lyoti�ce of Gotnmenaemenk is required. {p!C upgrades over$5004�
<br /> ""` Agent{€or the contsai:tor)a�F�wer o�Attorr�ey{for#he awner)would be someane with notarized letter from owner aulhorizing same •
<br /> • • r .
<br /> OVER TtIE GO!lN7ER PERMI7T! G (Frant af ApplicaBan ONy) •
<br /> Reroofs Sewers Service.Upgrades A1C Fences(PIot/SurveyJFoa#aga) .
<br /> �Dtiveiniays-fdoi over'Counter f oR public madways,:needs RO1tV ," � ' , ,
<br />
|