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Bullding i�epartn►enf <br /> Oate Reeeived -»� �- � Fhone Contact for Permifting �'# ✓ � ��-� I; <br /> r �� �I <br /> +Dwrier's[3ame. �rt'S�" .� �c.� tJwner Phone Num6er ,j ..... _ � 3 <br /> _ . .• �. . ,i <br /> tlwner's A,dc3ress ��1 � �� ,��c�-, flwner Phone Number�— �; <br /> � <br /> Fee Simple Titlehatder Name Owner Phone Numher� �'� <br /> Fee Simpte Titiehotdec Address ' . <br /> ' � <br /> JOBADDRESS SSI�D Iq�` � S� a LOT# ��_��` <br /> SUBDIVISION , �� � ;PARCEL:Ip# � - •1P C�.�•QCJ 1�j' (.�{�jG�:�:C.�� <br /> � � � (OBTASNEp FROM PROPERi'Y 7AX N0710E) <br /> � . , . . , <br /> WORK pRUPOSED � NEW CONSTR e ADD/ALT � SIGN�� MOVE. Q DEMf)LISH <br /> �` � ` �� `' ° INSTALL REPAIR <br /> PROPOSED USE , Q SFR � CQMM Q ' C3l'HER ` • � ' <br /> ; TYPE OF COt+tSTRUCTlON � BLOCK Q FRAME CJ STEEL Q OTHER • - " � � <br /> DESCRIP7'ION OF WORK�; ��P'TP'` �� °� � �-�' • � — � . . . <br /> BUILDING SIZE C�—� .; SQ FOOTAGE. H�MGHT � "�_� . � � ' <br /> Q BUILDING $� _r • ti r � VALUATION OF 70TAL CONSTRUCTION • � �, <br /> ��� <br /> 0 ELECTRICAL ($'-- � AMP SERVICE 0 PROGRESS ENERGY Q W.R.E.C. <br /> � <br /> Q PLUMBING ($ '^�} /� r��� .. <br /> � � � c.' ( <br /> Q MECHANfCAL $ VALt1Al'iON QF MECHANICAC.tNSTALLATtOit! � � �� <br /> , � � . <br /> GAS ROOFIt�fG SPECIALIY OTHER � • <br /> c� - . : � o o � <br /> ! FlNISHED FLOOR EL�VATtONS � � FLOOD ZONE AREA �YES QNO . <br /> � � <br /> � ... . <br /> �.UILDEF�_ .._. -- _- - --.__.._. .... _ COMPANY . �. , . : , <br /> S�GNATURE ` Re�is7EReo' Y/ N ,---F�E cuRaENr '" 'Y/N � " ' ' <br /> Address ., � 'License#: �- ' � ` ' �� <br /> ELECTRICIAN COMpANY ' � <br /> SlGNATURE REGI5TERED Y/ N �FEE CURRENT ''Y/N <br /> Address License#� �� � <br /> , PL.UMBER - , COMPANY • <br /> SIGNATURE: REGISTEFtED Y/ N FEE cuRRENT Y/N <br /> rf �.. ' � . <br /> Address - • License# � � <br /> MECHAMCAL COMPANY - ' • ; '�• ,. <br /> SIGNATURE EGISTERED Y/ N FEE CURR�NT Y/N <br /> s Addres� � � License# � � � �� <br /> . <br /> QTHER �COMPANY �. fY�t"'1. ��� . ���C,�r � <br /> SIGNATURE t REGISTER�D Y/ N FEE CURRENT Y/N � • <br /> Address r L�<< � M �-- ��JS�"I '`License# ����-�:��� � <br /> i2EStD8tV71At �- Aftach(2}Ptof Plans;{2)sets af Buildin�Ptans,(1)set of Energy Forms;R-O-W Permit for,new consttttctiott, <br /> -=:=Minimum len(10)working days after submittal dake. Required onsite,Construokibn Plans,S#ormwater Plans w/Sift Fence lnstalled', i <br /> 8anitacy Fac'stikies&1 dumpster;Site Work Permft for subdivlsionsllarge praJects � • <br /> CQMM�RCIA! Attach(3)sefs nf�Buitding Plans;(1)set of Energy Forms.R-O-W.FermiE for new co�struc�on. ; - <br /> M'inimum ten(10)working iiays afker submittal date. Required ansite,Construc6on Plans,Starmwater Plans w/Silt Fence in'stalled, <br /> Sanitary FaciEities&1 dumpster.Site Wark Permit for at!new prajects.Ait commercia!requirements must meet camptiance � <br /> SIGN PERNfiT Attach(2)sets of Engineered Pians. ' <br /> � """PROPERTY SURVEY required for all NEW construaUon. ' <br /> Directions: � � <br /> Fill out application completely. � <br /> Owner&Gon#ractor sign back of apptication,notarized <br /> (f over$250Q a Natice of Commencement is requirec3. (A/C upgrades over$500oj <br /> *" Agent(for the contr�ctor)or Power of Attomey(for the owner)wauld be sameone with notarized letter from owner aulhorizing same <br /> 'OVER THE CQUNTEl2 PERMtI"i1NG (Front of Application Onty} , <br /> Reraofs Sewers Service Upgrades A/C Fences(PIotlSurvey/Footage) <br /> Driveways-Nof aver Counter if on pubtic road�evays..needs ROW . <br />� � <br />