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e�3aso oz �,�-: , .. Ci of Ze h � ills Perm `"`��`��:"
<br /> . -9. Q:�r '�! ' .� i` ' , ;,p;•"';;�u F2uc 813-T80-0021
<br /> .A=. ,, , , ;.�,:. tY p Y �t Ap�,licati�n";�:�. n �� ���:�
<br /> .�. :�:'',��'4-' tr-' .
<br /> `ur`.�t:x� � ...t.,.. z, . Buit ing Departrnerit:�;l'>'�,` _ _ , �„
<br /> c cs"'���.'_ ' �'�•;,�;..'t":1�,.:.Y4`. - 2'.� ,°:;i...;'��r2::'',:':;%'t�`; ,.-.•:..�
<br /> . . . ' - ,. �t�i n9`f�i �1.':'ij�i1.°i
<br /> oat�RgcgiYea ._:�..:},�. -_,, _ -. -
<br /> Phone-Gontact,ar Rerm[ttin
<br /> Owner•s Name t- a � �" t:; 4- �t �.:.= '=`��••� .�dC � Owner Phans Number �:i�..� ° ; i�J�� �,i,j�. `�
<br /> Owner's Address ( ~� � �'� � r"�f �` �� U Owner Phone Number � �
<br /> Fee Simple Titleholder Name � � Qwner Phone Number r� �
<br /> (
<br /> Fee Simple Titleholder Address � '
<br /> �
<br /> JQBADDRESS ;r � � �• � j ��', f�, O� � LOT# C�__,�
<br /> SUBDtVIS10N C� + �� PARCEL ID#
<br /> (OBTAINED FROM PROPERTY TAX NOTIGE)
<br /> WC1RK PFiOPBSED NEw CONSTR ADD! LT- � SiGN Q Q DEMOLISH
<br /> e INSTALL 8 REPAI�
<br /> PROPOSED USE Q SFR Q COMM' � OTHEFt -
<br /> TYPE OF CONS7RUCTION Q BLOCK [� FRAME [J STEEL [�
<br /> DESCRIPT{ON OF WORK 1'� � �J � C�1 ?�-i � t., � j �
<br /> ' !� r
<br /> BUtE.DING SIZE "�� 3� � O �I � SQ FQOTAGE ���•�z� �HEIGHT oZ(7 �G)�
<br /> �8������ � j �' 0�=� VAL.UATIO� OF TOTAL CONSTFtUCTION
<br /> -•--J
<br /> �ELECTRICA� $ � �,�� Q{� AMP SEft"tCE Q PROGRESS ENERGY � W.a.E.C. �
<br /> �Pl.UMBlNG $ �p �a��
<br /> � $"��� `
<br /> QMECHANlCAI $ VA�UATIQ OF MECHANICAC 1NSTALIATION �
<br /> QGAS Q ROOFtNG Q SPEC A�TY � OTHE12
<br /> F�NISHED FLOOR ELEVATIONS FLOO�ZONE AREA [�YES NO
<br /> I
<br /> Bv��QE� � ��,�,�. c�aMP,aEt�r ���� �I X�N �G'�5 R j0��"�C
<br /> SIGNATUFtE REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address �'7"Gc� /� /�,. �' 17� �I�/�J� �y0 Ltcense# C� � ._�
<br /> EI.ECTEttC1AN ��r�^� ,{r, z��MPANY t��' �7 ��� `.�tC G,�.rG'�
<br /> SIGNATURE ��� F I REGISTERED Y/ N FEE GURRE� Y/N
<br /> Address License# �"`tr""�C7f.�-��r�
<br /> ,
<br /> �P�UMBER � ^�'�� 3� CiOMPANY "�""-'�'/�`-S �`c3'���v�'2�,.,,� �(vt���
<br /> SIGNATURE �� � � -LLJ/'����-"'�--•• � REGISTERED Y,% N FEE CURRE� ,/N
<br /> ..—
<br /> Address :) (��S j7'l C-��\1�5,�`L �J�S<�`� License# �.1-'� (��c�S�..0{J%'�
<br /> MECHANtGAL GOMPANY
<br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address � License# � �
<br /> OTNER COMPANY
<br /> SiGNATURE R�GISTERED Y/ N�. Fee CURa�n Y/N.
<br /> ��t$� � license# 1 �
<br /> RESlQEMTIAL Attach{2}Plot Plans,_(2}se#s:of.6u1ldittg'P1ans;(1}set of Energy�_Farms;Ft-O-W Pecmit(or aew construc6an,
<br /> Minimum3en.(1.0}working.days,after.submittal date. �equired onsite,Constructlon Pians;Startnwater Plans w/Silt Fence(nstailed,
<br /> Sanitary Facilides&.1,dumpster.Site WorfoRermit fo.subdfdislonsAarge projects
<br /> Ct�MMERCiAL Attach(3)compiete sets af Suildlrig Plans plus a LIfe�Safety Page;{1)set of Energy FoRns.R Q-W Permit for new construc#lan.
<br /> Minimum ten(10)worktng days�after submittal date. �tequired onsite,ConstrucUon Pians,Startnwater Plans w/Silt Fence installed,
<br /> Sanitary Facilitias 8 1 dumpster.Site Work Permit for all new proJects.All commercial requirements must meet comp{lance
<br /> 5lGN PERMlT AttacFi(2}sets of Ecigineered Ftans., °-
<br /> ""PROPERTY SUR1/EY requfred for all NEW const�uction.
<br /> 4frecticns:
<br /> Fill out applicaUon completely.
<br /> Owner&Contrackor sign back of appltca�on,natarized
<br /> 1f over 52500,a Natlae of Cammencement 1s reyuired. {AtC upgrades over a7500)
<br /> " Agent(for the cantr'actor)or Power of Attomey(for the owner)woul�be someane with notarized letter from owner authorizing same
<br /> DVER THE COtfNTER PERtVlI7'TING (Front of Appllcation t?nly)
<br /> Reraofs if shingles Sewers Servfce Upgrades AJC Fenc s(Piot/Survey/Footage)
<br /> Drlveways-Not over,Caunter if an pubtic roadways..needs ROW
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