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<br /> �� �� 'r_-l ..� ;�_ � Phaona.Contact �ar Parmittin �! � `��`� -- ���5.�
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<br /> oK�ners►�ame �..r.��»"� (��j�`2;i 7�` .�,�, Owner Phone Number S13 -�}79 - 3� Z�
<br /> Ow�rior's�4ddresss C�I L� '� �e r��"� /1✓e. �-�+�7�s �/ 3 2 Ownar Phone Number ____�
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<br /> FeE�:3lmpte Tiiieholdi�v�lamc+ �;�_ Qwner Phone Number C ___��
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<br /> Fee�Rimpie Titiehold��p�►ddr�ss �;� � ___��
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<br /> JO(B ApDRESS ���'�`�� �,�`2 �v�...7�-P � h�'ti Fi._. 3 3�`r�� �as# C_���.J
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<br /> su�o�v�.►�ar� �:�S� A�;�2�, PAR� L1D# �"3-Zb— � c�a — �
<br /> � (OBTAINED FftOM PRpPERTY TAX NOTIGE)
<br /> WC�EtGC PF.tQROSf�D (NEW(CQNSTR ADD1A T � 51GN Q � D�MQl.ISH
<br /> � IIN?iT�ALL �� REPAI
<br /> P��E�os��us� � �SFFt C� ca�M � o���R �"'— ���
<br /> TYPEE OF CONSTFtU�VIf)N [� ��LC) K �� FRAM C,� S7EEL [� �'����
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<br /> pE;SCRtPT10N O�Wt)RIC �����1� (D J�� (''f'_� D .� +2N�, y �o� � 1"�� � 1�c,� „�;�,��1�V@
<br /> !�" �-y,R i r'1/ L r�a'�9!'c. �o,qT-2.
<br /> BU�[.�lNts SiZE C_� SQ FUOl'At3E NEIC3NT
<br /> [I3�R. �I� iRI�Fi
<br /> '-=-=�""��'�l�� � �,� � VALUATIt� OF TOTA�CONSTRUCTION
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<br /> I����c�r��c�,�. � ; AMP$ERVI � Q PROGRESS�NERGY C� w.R.�.c.
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<br /> I�PLt1M8lNG $ 4�'�`�"
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<br /> ��MEGHANfCAL $ � VAtUATlt) OF MECHANlCA�INSTALLATION
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<br /> I�GAS 0 i�oc�F��r� C� s���i �.rt � o����
<br /> FINIaHED FLOOF!ELI:Vf1TIONS T�—'� FLOQ ZONE AREA , �YES NO
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<br /> Bl31l.pER �'1�iC-'(,� � ` � t: �MPAPtY �����e S_ l-�an+•�, G e��r�2�'�p� �—]
<br /> SIGNATURE � j flE ISTERED Y/ N FEE CURRE� ��I
<br /> Address �J �c�� �� �JI`r��,`-" �' '�,��`�yA �tu{c 3`Z-`b 7� Llcense# C..�aG � 5� ��' �._�J
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<br /> ELE:t;TFttt;lAN � t; �MPANY �]
<br /> SIGNATURE �, ' RE ISTEREQ Y/ N FEE CURRE� Y/N Y
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<br /> Address �� �e�� _�� Llcense# � ]
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<br /> a4tlMB�Ft ? ! t; �MPA�IY �]
<br /> 31(3NA7UtltE � i l fZE I$7ERED Y/ N FEE CURRL� Y/N
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<br /> l�ddress �� j y� � � Uaense# C ]
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<br /> VlEi;t�ANICAL , � � , t;�MPAfi1Y ��
<br /> 31GN�►TU4ZE ; fIEGISTEREO Y/ N FEE CUFtRE� Y/N
<br /> Addresa �„_„ ;�,�_______, � _�� Llcense# C �
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<br /> �TN�R # � � I:�MPAFVY
<br /> 31GNA7Uh2E �� ; i R 197ERED Y/ N FEE CURREA Y/N
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<br /> Address C� � ; License# C _�
<br /> fiNti�t�M�tttftf�hh�H�H�i�Hi�-f-F�hh�tf�tttft�f�itP��t�tf�H+ � Hiittl-Hitt1
<br /> 2E.i14}EN'ffA1. AttF3ch{2)Piot Plans;{2�se�s af Buildfng Pian's;(1}set of Energy Forms;R-O-W Perml#far new canstructlan,
<br /> Minimum ten(10)wa�kir�g dti s after submitta�dake. f�equired onslte,Construcdan Pians, Stormwater Plans w/Silt Fence Installed,
<br /> ,.__---___�., Sar�lia�y_Facll4tles.&1-d�tmps er,-8lte�Cltork�P_ermlt�fo[�_su�divlsions!}arge..pr.oJects :__-. -
<br /> :OMMERCtAi. Attt�ch(3}complete sets of E:3 iiding P1arns plus a i.ife�afety Page;(9)set of Energj+Forms, R•Q-Vi/Permit for new construction,
<br /> Minimum ten(10)worki�;�g dt�'s after submittal date. equired onsite,Constructlon Plans,Stormwater Plans w/Sllt Fence installed,
<br /> Sanitaty Fac(litles&1 d��mp�er.Slte Work Permft for�a11 new prof eots.AN commerclal tequlrements musf ineet campllance
<br /> 51t3M P�RMIT Attf►qh{2)aets of EnglnErered Pians. ;
<br /> """PROPERTY SURVEY ro ulred for all NEW canstructlon,
<br /> �IIZ]II�t��TI
<br /> �irF�c¢lon�: ; i '
<br /> FIII out appilcatfon completely, ; ;
<br /> Owner&Cantractor.,Ign back of appll�;af(at�,notadzed
<br /> If ovE�r 52500,a Motice of Commenceimen�is requlred, (�UC upgIrades ovpr 57500)
<br /> '" Agent(for the contractor}ar Power Qf E�ttom�ey{for the c�wnet�wauid be someone w(th notarfzed ietter from owner authorizing sams
<br /> 7VEEI�THI:COUN7ER i�EiRMITTING4��•� >�•�(Fr�r�t�of�Applicaklah Only)
<br /> �er��ofs It sMngles SE�we�s Serv�ce lJ grades A!� _, i Fence {PIoUSurveylFootage)
<br /> Urfvaways-Not ov�r��ount�rif on public ro dways:.ne�ds R�OW
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