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<br /> ; Building Department
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<br /> �7�'"J �""" ' , Ph�one.Contact f.ar Permiktin � � 3 'Z�. -
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<br /> )wn�u's Name _�AI�.�2f�3�, ��(��` I�.) Owner Phane Number p��° � ^�'( Q�
<br /> ?wnar's Address C S�r�Q � � Owner Phone Number C �
<br /> (� �'ee:iimple Tit{efiotder N�ame �;� �� Owner Rhane Number C
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<br /> °ee:i(rnple T(tieholder A�ddrass ; � � �
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<br /> �ae��r�di�ESS �,�2,'� '1'7� ,gv� °Z�eAhr�y y,�i 1 s FL '3 3�y"'Z ] �.o�e# !� �f'Z
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<br /> 3ufs����YiStaN C:`�t t�� „�d'&!� �,s 11S � PAR�El.tD#CI -2v-Z.P-Qd�p-c`7 i Y t��} �- +B t a p �
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<br /> i (08TAINED FRdM PROpERTY TAX NOTICE)
<br /> tYOF�K.Pi30PO3�D �NEWICONS7R RDDIAGT � SIGN Q � DEMOLISH
<br /> e iINS1�ALL �� F2EPAIR
<br /> aftt}Pt�SfcD.U3E � #SFi�t� C� COMM OTHER (��
<br /> IYF�151�F CONSTIRUCTIGIN Q �BLC)�K �� FRAM STEE4 [�J
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<br /> ae:;��ia�rtoN or�wt�arc �'�5i•�t/ ,�PP�o•� ° � � � �cQ �6 p�.�.�t ��v 60� d�
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<br /> BUIL,i�INti SIZE SQ FOOl'At3E FlEiC3HT
<br /> cza�a�a ��ucr��cci �
<br /> �—� $������� � �' ��c�"� VALUATlt7N OF TOTAL CQ1s1STRUCTION
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<br /> �_�ELECT�tSCAI. $ 4 AMP SERVICE � PROGRESS 4�NERGY � W.R.E.C.
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<br /> ���PLUMBINC3 $ �
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<br /> [_�MECHANICAL $ ' � VALUATIt)N OF(uiECNAN1CAl INSTALLATION
<br /> ��GAS Q lRC►t�,FiNG �� SPE�IAl.TY � OTHEft
<br /> FINISHEC►FLOOR ELEVATIONS ' ��� FLOOD ZONE AREA [�]YES NO
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<br /> BUtt.��Ft �/f"�) t20MPANY C.c3r.a�eS t-�ca�'+��. Cer.i���.'t� �
<br /> 51GiIV�1TURE ` � /, d��j ° � REGISTERED Y/ N FEE CURRE� �Y J N
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<br /> Aeddress �o �o� "�$i!�,`�� �=���'t��' 3z�7� License# �..��, l s"� ��-t :l �
<br /> � ��M�� �
<br /> El,�EC'tR1CtAN ' t20MPANY _�]
<br /> SICi111ATURE � ' � I FtEGISTERED Y/ N FEE CURREA Y/N
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<br /> Address C� ;_� � L(cense# C _]
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<br /> PLt1MBER ; ? # t;OMPANY
<br /> 81(�WATURE i I � PtE01STERED Y/ N FEE CURRL� Y/N
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<br /> F�ddress � 1 i � � � L(cense# � _�
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<br /> ME:CFIANICAt� � ` t�OMPAiVY
<br /> SI(iNA1TIIRE ; ( ftE01STEREp Y/ N FEE CURRE� Y/N
<br /> �iddress C,,,� � �__,_,�_,,, � � license# C �
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<br /> Ot'N�R ' � j �OMPAWY
<br /> 81�3NATIJRE _,,,,,_ �I�,__,,, ftE01STEREp Y/ N FEE CURRE� Y I N
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<br /> �ddress � i �_��� LEcense# C �
<br /> ii�41-Ftf�ti�tiii�Fftt1tH�t 41�M�tfii-hH-M�tf-li-httii-h ++fti
<br /> RE:af�ENT1AE. Attach(2}Plat Pians;(2 sets�of Bullding Pl�ns;{1}sef of Energy Farms;R-Q•W Perml#far new construcUon,
<br /> Mlnln�um tan(10)workl�g dFi�s after submltkal date. Requlred onslte,ConsVucUon Plans, Starmwater Plans wl Silt Fence Instalied,
<br /> — -- Sanitary Facflltfes&-1 d�lm���er;SI►.e WorkPsrmlt for_subdlvislons!large proJegts
<br /> CqM�IERCtAt, A4tach(3}complete'set,of EI ildtng Plans plus a Life Safet}r Page•,(1�set of-Energy Farms.-R�O-VV Permlt for new canstnsotlan.-=---
<br /> Minirnum ten(10)workirjg d�y�s after submittal date. Requlred anslte, Constructlon Plans, Stnrmwater Plans w/Silt Fence Installed,
<br /> Sanl(ary Fac111tles 8�1 dt�mps�er.Slte Work Perrnit far ail new proJects.Ai!commercia!requlrements must meet compllanoe
<br /> slaN PE;RMIT Attaah(2)sets of Engln��ere�i Plans. �
<br /> '""'PROPERTY SURV�Y re uired for all NEW constructlon. �
<br /> ILLFILLT�II3�.'Tx.'l7�31�3 LLfi�Ct�
<br /> Directions: i j �
<br /> Ffq nuk application t:ompletely. � � �
<br /> Owner&Cantraa#or sign back of appll�:atlan�,natarized �
<br /> If aver S2S00,m Nc�tice of CommencE�men�is requlred.i (A!C upgrades ovar S7500)
<br /> *• AgQnt(for the contractor}or Power of f�ttom',ey{for the c�wrj►er)would be someone with nota�ized letter from owner authorizing same
<br /> O'VGIR THE COUNTE:R IPERMITTING�i '(f�rur��of�Applicatloh Only)
<br /> R�eroafs!f shingias Sewers � 8arvdce i1 grades A1� i Fences(PloUSurveylFootage)
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<br /> Driveways-Not owar CounEer if on publia ro dways;,nee�ds ROW
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