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� ' e��-�aaoa2o City o Zephyrhitis PermH Applicat3on F�-e��-�eaoaz� <br /> 8uuding Department <br /> fi�l YlC'Z�'�r� , <br /> Rat�s R�ivW �s��6 f 5� Phone Contaet for Wrrmktin �'3 � �5�Z l �j��5� <br /> Owner`t Namo /�O.��a�.� �7xtw t-- I Owrr�Phom Number l/"3 �7 S���l 1 l <br /> QK110f'fF Adtlffld '�'O ��,D �D P�Lra�rJ P ��j K.. OwtS6i PhOM N413T466t ��_ � <br /> Pa 8tmpl�Tftbhatd�e Nsme � � � � Ow�wr Rhort�Numbst � � <br /> I <br /> FN 81mp1�7kl�holdrr Addnos I � <br /> J08 AbDRESS -"��ra M�s- �1 S A�3a v� ( i07• �� <br /> SUBLtiVi3{43N ��`��I Pl�RCEI.iDB <br /> (Db7A@IED PROY VRQPERTY7/Ut NOiiCE� <br /> WORKpROpOSED e NEWtOtU''TR� App/AL7 � SIGN Q [� D6MOI.ISH <br /> lNSTAl.t. itEPAfR <br /> PROpQ9ED USE Q SFR Q C4MM � �TNER rw �r� 'cr i t.*-�.- <br /> �I TYPE OF CONS7RUC110H Q gLOCI{ Q FRAME C� STEEL Q <br /> I <br /> ' DESCRIPT1dNQF WORK .-; Ef`�. ��Mo . IOr�C�. �1zu�ti un t+S <br /> � awus�r�cs� l.z�zc�a �£� i�.�' �soFao:�� / � S ctFac►t� '( l� <br /> {n <br /> �BUtLD1NG $ r f��U VALUATION OF TOTAI.CpNSTRUCTION <br /> [ZY�ELECTRICAL �� (AMP SERVlCE [� PROGRESS ENFJ2C3Y �] W.REC. <br /> {�PlUMB1NO ��� <br /> [�MECHANICAL �� ALUA710N OF MECHANfCAL INSTALLATION <br /> �GAS Q ROOFIS�7C, Q SPECiAL1Y� OTHER <br /> FIN1541E0 F104R EI.EVATIONS �� fl.OQD ZOMEAREA QYES NO <br /> i <br /> BtALOER � - /�.ry i`'� / CONPAHY SrI�� �G.c�S�-t..c���cx..i �j-.c.� <br /> ' SIGHATURE /�. �f��.•., //�' I �psrvi�a Y 1 N �CuRRt� Y(N r. <br /> /w�beas ,�5� ld.e�i� ��zr��k r���5 iG�?:�.:-C„ 33SbE- ucense#� � <br /> a.�cr�cr,w ,�,4,�f�i�`-�—�' � coMP,wr l�ow�und Et�t��t�ti �'err�F�"Y � <br /> , SIGNATURE t�psr�En Y!N �EWar+�n Y!N <br /> I <br /> aaa�e SIl7 S• a /url�¢r'�F11� t?lanf('�� �k- 3�' uoe�s. �(�`�c��3�. ] <br /> PLUMBER CQMPANI � � <br /> SIGHAtURL ���`ry�� �p�m Y I N FEE cu�r. Y/N " <br /> naa..s. � u���o ( � <br /> MECHAlUCA! � � COtAPANY � <br /> 910NANRE eEOWT�rzEn Y!N �E CuRit� Y/N <br /> Addnase � LICEnss p� � <br /> OiHER CUNPANY <br /> SIGNATURE � � kEGISTqtED Y I N FEE CURFEn Y/N � <br /> Addf08s � Lk9tlse i{ l T! i <br /> RESIpENTIAL Atlach.(2}Plot Pla�u:(2)sefs oi BWlding Piara:{t)set W Entsrgy Facm�;R�O-W Permlt tct ttew oonstrudlon, <br /> t�nftnum ten(1C}wakfng days sfter eubmt�iat daie.Rsqu6ed ort�tte.ConehucUati P{�ns.Siatmwater Ptnns wl SAt Fmce Ineteited, <br /> Sanllmy FaWUtlea 81 dumDStec;9Ne Worlc PeemK for subdhAaWnsAaige Proleets <br /> COMME3tCtAi. Atauh(3}mmpiete sais of 8utldEng Ptares plus a tlfe SsTety Pege;(1j Bet of Enetpy Forms.R-0�W Pertnri tur new mrutruq3on. <br /> Mnimum ten(10)wo�klnQ deys after submlflal date. Re4u1ros1 ona3ts,Gonstrudbn Plas�a�S#amrwaler Piams wJ 5�t Fenee inatatlod� <br /> Senitaty Fec�Cks 8 S dumpsiec 9iie Wmic'Pstmft tor e!I rtew DroJeda.Ai�wmmerdal roqulremen6e must meet canptlenoe <br /> SIGN PERNIT Attech(2�aels of Engk�eased Ple�rs- ( <br /> "`•PROPERTY 3URVEY reqWrnd 1or GI�NEW aonsWdkn. <br /> Dlrielioite; <br /> F[A ou!epplfeaNan complatdy. - <br /> Owner 8 Cor��trecmr sign badc of eppllptlar,rwfar�zed <br /> N ewr f2300,a NaU+rA ot Comlrr�art»rr!b rputnd. (AtC upgrad�s awr 37900) <br /> ^ Agent(for 6io canUacdOr)or Power o1 Aflomey(ktr the wmar)would be samenne wiih natarized letter from awner aWhorizing aame <br /> DVER TfiE COUNTER PEAMT1TiHG (Front otAppiMatb�n dniY) <br /> Reroots It shingles Sevuers ServVee Upgcadea AtC Fences(PbUSurvr�ylFoMage) <br /> pclvrweys•Nok avar Casu�ter q on pubilc roadways..needs ROW <br /> � -- <br />