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o�ia-rau-uu�u ! l;liyOTLep Y��IIISF'@�fTlli'HPPIIC8il0� rax-ai�-ro�-vuci <br /> t� I ; uilding Department <br /> �. MC'N e�c_la <br /> Date Received — up��� phone Cont ct for Per�n(ttin (,3 26 -- '`�'1�t�S <br /> Owner's Name � � �p I /l t 2.�� 5 Owner Phone Number �3 ~7$� � ���o � <br /> � <br /> � -�Owner's Address /�r� i Owner Phone Number <br /> Fee Simple Titleholder Name i Owner Phone Number � I <br /> � � <br /> Fee Simplo Titleholder Address � � <br /> JOB ADDRESS �s�Z- �21�� GT �lLy�o�IjS f=L � � S� ��r k N �t y� I <br /> SUBDIVISION y�`���W(1B� !b� Zr►l�ItSPA CELID# C�.Z'ZC�°�J 'OZIA -Qd.LC9� " OdL(O I <br /> (OBTAINED FROM PRi�PERTY TAX NOTICE) <br /> WORK.PROPOSED e NEW�CONSTR 8 AD /ALT � SIGN Q Q DEMOLISH <br /> INSTr LL RE AlR <br /> PROPOSED.USE . [�. SFRI Q CO M 0 OTHER C � <br /> TYPE OF CONSTRUC�TION Q BLO K Q F ME � STEEL Q � <br /> DESCRIPTION OF WORK �f� � � c.cl titN s 1�"S "H (;.n�r T Sr'7.�C.�s� Z� I <br /> %L 1�7�6 � <br /> BUILDING SIZE SQ FOOTAGE HEIGHT C� FL (T(a�(o <br /> BUILDING $ 3�53. �e:� VALUA ION OF TOTAL CONSTRUCTION <br /> QELECTRICAL $ AMP SE VICE Q PROGF;ESS ENERGY Q W.R.E.C. ' <br /> QPLUMBING $ � <br /> �� � 2v <br /> QMECHANICAL $ VALUA ON OF MECHANICAL INSTALLATION � <br /> [�GAS Q ROO�FING Q SP CIALTY Q OTHER <br /> FINISHED FLOOR ELEVATIONS � FL OD ZONE AREA QYES NO � <br /> � <br /> � ��� itti-Fti-Ftl-tt� ��� �-tti-G <br /> BUILDER L OMPANY L�+�-�S l�oM�, CeNT�2�i � � <br /> SIGNATUFBE REGISTERED Y/ N FEEE CURRE� �Y/N- <br /> Address O �O!� o ��J ��A� `' 3 Y'��� Ucense# ���o G � J � �5 �� _1 I <br /> ELECTRICIAN <br /> � COMPANY �I <br /> SIGNATUFtE REGISTERED Y I N FEEi CURREA Y I N <br /> Address License# �_ I <br /> i �PLUMBER I COMPANY <br /> SIGNATURE I REGISTERED Y/ N FEEE CURRE� Y/N <br /> Address License# I <br /> MECHANICAL , i COMPANY ,N —J <br /> SIGNATUfiE REGISTERED Y/ N FEfi CURRE� Y <br /> I �Address i License# <br /> OTHER COMPANY � J <br /> SIGNATURE � REGISTERED Y/ N FEE:CURRE� Y/N <br /> Addross I License�# _.1 <br /> � � <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets�of Buiiding Plans;(1)set of Energy Forms;R-O-W Pennit for��ew construction, <br /> Minimum ten(10)working da s after submittal dat . Required onsite,ConsVuctlon Plans,8�tormwater Plans w/Silt Fence installed, <br /> Sanitary-FacfilUes&1 dumps�er;Site Work Permit or subdivisions/large proJects <br /> COMIIMERCIAL Attach(3)complete sets of B ilding Plans plus a LI e Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction. <br /> Minimum ten(10)workfng da�rs after submittal dat . Required onsite,ConstrucUon Plans,:�tormwater Plans w/Siit Fence�installed, <br /> Sanitary Facilitles 8�1 dumpster.Site Work Permit or all new proJects.All commercial requii•ements must meet compliance <br /> SIGN PERMIT Attach(2)sets of Engineeredl Plans. <br /> ""`PROPERTY SURVEY re4uired for all NEW co truction. <br /> C]a1 <br /> Directlons: � <br /> Fill out application completely. <br /> Ovmer&Contractor sign back of appl(catior�,notarized <br /> +• If over 5Z500,a Notice of Commencemer�t is requlred. (A/C pgrades over b7500) <br /> Agent(for the contractor)or Power of Attorr�ey(for the owner)wo Id be someone with notarized letter frorri owner authorizing same <br /> OVER THE COUNTER PERMITTING (Fro�t of Application Only <br /> Reroofs if shingles Sewers Service U grades A/C Fe ces(PIoUSurvey/Footage) <br /> Drlveways-Not over Counter if on public ro dways..needs ROW <br />