|
i —
<br /> � ' /"'�---�.. ( � Building D�epatiment ,
<br /> �, � - . .
<br /> ' Date Receive,d� � ,�""�'c�, ' k'hone ContBCt for Permitting �Y�.. �).,d,,, Y. .=!'/.�',2 -,, .
<br /> r1 '' ` • owneir Phone�Number' � Fl�'.3-- .�'— c�"" �
<br /> Owner's Name • - .
<br /> j��' /� � ' � 1
<br /> bwner's Addrgss � �+-°� . G�+�' Ouirrtsr Phone Nua►bei� -
<br /> . .� - j ' .
<br /> Fee Simpie`Titlehaldec Name �• I ' Owner Ptione Number
<br /> . i. • . . . .� ..
<br /> Fee St�ripiaTittebolder Addi ss`'' f . . .
<br /> JOB ADDRESS /�lf� �..C'�l • � . ' LOT:#E .�� .
<br /> . , , . . , . , .
<br /> , ,� � C�./� �c/`� ; PAR�E�tD# /l-�--2Q"- -- 0�2d"��� '�/C�
<br /> SUBDIVI310N, ' � ,
<br /> _ • ' ' . � . • �OBTAIN�D FROM Pi20PER7Y7AX NOTICE) •
<br /> WORiC�'R.i3PUSED ' , ', idEW GONSTR aE ADDlAI.T [� $!GN �[� . MOVE •[� DEMOLISt-1 , ,
<br /> ' � � INSTAI..L: : � ..REiAIR . . . .
<br /> PROPdSED USE • . Q � SFR �- COMM Q OTHER � •
<br /> TYPE OF CUNSTRUCTl4]1Y Q ; BLOCK �, FRAME ' .[� � STEEL Q OTHER[�,�~ �-I
<br /> � DESCRIPTION OR WORK. � .Cf ., Gr.�.' � �G` �'r.� � � � �L'��`�`��'.
<br /> BUILDlNCy S12E. - � SQ FOOTA�E � I'�� ' HEIGHT �_,� •
<br /> I ' ' � • • _ . . . .. .
<br /> L] BUILDING $ l . •VALUAT{Ol�I OF�'OTAL CONS7RUCTIQN _
<br /> ,
<br /> C] 'ELECTRICAL $ - 4 • • . AMP S RVICE Q PRt3GF2ESS�ENEFi�Y • � W.R.E.C.
<br /> Q l�LUMBING ' $ ��� •�_ . �j"j��� • �(kVt,� .
<br /> "� �. � � . . �� � =2 s.�-�P
<br /> [� MECHA�iCAi. $ ti i ; . . .. " Vq�UATtON.OFMECHA(�ftCALlNST�1UATlC1tV � �`�1"�
<br /> 3 �.
<br /> �
<br /> i � � GAS r, Q �, ROOF1NCa- ,� . S�EGlRt.TY � `OT!-!E!�' � _ • . .
<br /> FtiVISFiED F1.00R ELEVA ONS ' . F IClOD ZONE AREA . �YES` �[�NO �
<br /> . , .
<br /> St11LDER 1 . . a�. _YCOMPANY + f"!�"��M1.�E`'���/'�� •
<br /> SI�NATURE ��u #��tsr�o � ! N " 'r�cuR�r .Y�/N '
<br /> Address /.Y,73 .Ir� 1 � c^l�.�rr- � '.3.?7 - � . .. u���g�.` C'�s°C"/25"'�l���
<br /> - - I . . . ���
<br /> ��.�c-r�ic�.: . � . . .l:-,�Ca6�pa�iY � .. ' - - .
<br /> SiGNA'Ct`!RE � � REGlS1'ERED . ."' Y/ N _ - '�F�E CURRENT - Y/N �
<br /> Addresa� - � ' �� ( � ' License# ' .
<br /> � .
<br /> PL.UMBER '' . � . ' '�t . , COMPANY. ,. � � . . -
<br /> � SIGNATURE• • EtEGIS7'EREp Y/ N FEE GURRENT ' �Y 1 N
<br /> ' � Aadress i ' • . � , !. � 4 'Llcanse# ��--�
<br /> � MECFF��AANICAL . , • . , ( f ' � . CDMPANY �
<br /> • SIGNATURE � � �ttEG�si'�RED Y I N , FEE CCiRREN3' " Y 1�1 , � . .
<br /> � . Address � - - • " ' � � , _ .Liaense# 1 �
<br /> ' , _ .. . � , • . ' _ � .
<br /> .—. .OTflER' . __. ..--..--__.�._._._..__ ' ._ • i '
<br /> SiG1VA'IURE -'.. �.�. , � iz��tsTE��o � ' `f i N �Cu�Etil' � • ___'.
<br /> Address ' � • - - • ( ' ` • ` License# •i , i
<br /> �
<br /> RESiDENT1AL Attac�t(2j Plo Pians;(2)sefs of BuiEding Pians;(9)set af�erg}r Forms;R C1-W�Permtt�for ctew constructlon, . .,
<br /> . °Minlmum,tea. ,0}warking,days after submiktat date.) Required onsite,ConstrucUon Plans.Stormwater Plans w%Siit Fence installed,
<br /> ' Sanit��a r�,�acill es 8�1.dumps;e'r,Site Work Perirtit for subdivisitinsAarge projeoEs�
<br /> COMMERCiAL . ,A#tac;h.(3j co piete sefs of 8uilciing Ptans p1iJS a L'ife Safetyr Page;.(1)set•of Energy For,�t�s..R-Q W!'ersnft for new constru�flon.
<br /> . � �Minlijatun Eest r10)vuorkirig day's aftersu6mt#tat date� Required onsite,Qonstructian Plans+Stormwater Plans w1"Silt FenCe•insfalled,
<br /> . -_ _. Sanitary Facil_4ties&1 dumpster.Site Work Permit for ail new projects,Alt commercial requirements mUsk meet compliance
<br /> ' SIGN PERMiT Atfaah(2)sets of Engineered Plans. ' � , _ � - - - - - - - -.- ---�--
<br /> . ''*.'*F�20PER3Y BURVEY required fpr aii NEW.consWcfion. • � ' -
<br /> . i�irectidns: ' • _,� � . ' • � ? � ' � : �
<br /> �s1t out appiication compiete�y. . . '• , - . .
<br /> OVUner 8�ConU'acta��ign b�cli�o•P application,notarized ' � ' , • '
<br /> If iiveP�2500,a Noti�Ce of Cqinmenaemenk Is reyuired. (A1C upgrades over�5000j � -
<br /> "" Agent(for ihe contrautor)or P w�r o�Attorr�ey(for fhe awner)wouid be someone witfi notarized letfer from owrcer authot�zing same •
<br /> .. . . � .
<br /> OVER'17iE COUN7'ER PL'RMITfI t1 (Frant aP ApplicaGon Ontyj -
<br /> .Reroofs 8eu�srs Ser+rice i.}pgrades AiC Fences(PlotlSurvey/�oa#agej • -
<br /> Driveways-Nat over�ounter f an pub�ic roadways.:needs ROVN �
<br />
|