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6uilding DepartmenE
<br /> M't�N-i c;A
<br /> ._.._ ..__..�_._...�.... . .
<br /> Date Ftece3vfsd -�' 'f I Phone Conta�ck for Permitting �L� �2�� --��,'-..s`� �
<br /> ' maz� �1� 2'a�h tts�n�tt � �u�t r.et�:
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<br /> Own4v's Name L � tn��'���um -�--.�-�����-r� �-7�. Owner Phone Number x C3 i -� 3"�� ,- 2.r7?� �
<br /> Owna,ir's Addlress �7 Y,�:=: 1 �� 'S� �_ _„i Owner PhonQ Numtser ��, _,,,�,�
<br /> . �� , �.�.
<br /> Fee:iitmple 1'itlehoBder N�me ��_,_ _�� Owner phont�Numk�er C^, �
<br />� Fee;i�imple 1'ItlehoVder e�ddress �� _,._,r .`._.. r.._.�
<br /> �aa�ooaE;;ss �._�17`�� 17TF, 5T ?.�.�PdRY�►'!15 F�. 33 5�y2._.�_� LOT# I��`' /J .�
<br />� SUBK�IVlSiOi�l �!'�aa2e 5 �ST/��Q9,� PAR�C�L t0#� ^� r__„�
<br /> l (OBTAINBD FiiOM iyROPEFtTY FAX NOTICE)��
<br /> 1MOR#:PE20F�QSE� NEW Ct}NS7R ADD7A�T � SIGiJ �� C) DEMOLISH
<br /> lNSTAL.L i.� REPAIR
<br /> PFtOIF'OSED US� C] SFR �,� COMM �] Q'TNER [i�_____� i,�.]
<br /> NPEi OF COWSTR►JCTlG)IN � BLpGk+; (_� FRAMI:: [� STEEL �,_] C r_i,'
<br /> DESI:IRIP710�IV�FINOF2f4 ���`j(aC2. lo WiN���,(,1�e'�S (�!� 5i1.E?�Sr'� ��,,, 1{�,,�,¢3 F� r,��
<br /> . '..— l.sN �i-�� FL t"5''`ZS
<br /> HUiL[�iNG SIi:E C.r..,._ � !sQ fiOF�TAGE�_._.,.�I OC9dH IGH7 �._... � Si'?2 �
<br /> zu.ui:a�uazr�uu x�ar�t��. � ;r�a;c��
<br /> �-�—a"�«"d���' $ L��S-�" '3� VALUATIUN 01=TOTAI,CONSTRUCTIqM
<br /> [-,���I�CTR1t�A� $ AMia SERV(CE � f'RO(�RESS ENERC9Y Q W,R.E:.C,
<br /> ,._.._._,..._.._�
<br /> [_,�PLfJN3BING �� � �
<br /> [��MEC:NANIGAL $ � VAl,UAT(t�N Oi=ME:CHANICAL INSTAL(ATiON � � ��
<br /> �
<br /> [_�GAS Q E200FI�1G �_� SPECIALTY C� OTHER
<br /> FINlSHED FtCfOR E;L.EVAT'IONS �� � FLOOC7 ZC)NE AREA �YGS NO
<br /> tti-ttH�-l-ti-tttl-thtttH-l-tf�1-F �tttf-ttti-ttti-t. 7 httt�ii-t.�t tfi�ttt-tt�El-QtFfi�tfttti-t�ti�ttfi�ttF#-h3i�thttFF��ti��
<br /> 'T AntTy'+ant 2a �tL ����J �� �.�
<br /> BUILIDER /�� � ��� Ct7MP'ANY f, ~ �~
<br /> StGtdA,TURE t^"�wP''$-� ��M'� ���'S 1"Gt— RlcGISTEREp �'' � Y/ N ` FEE CURRE� Y/N �
<br /> �Addr@SS �'0@ �O`!� �$l�"�� bf��Rt�PO�m �lrr3"Z.S?8`_� L.icen:ye# �_ �`.,�
<br /> ELEC1'RICIAIV �.Y C�(�MP'ANY _ � ^__,�
<br /> SIGt�IATURE �.�__ _ REiGISTERED Y/ N FEE CURRE� _ Y/N
<br /> ��uidress CT,_� _ _ „�� Llcens�# ��- ——�
<br /> �LUNI!!IER �-Y-- 4 CIJMP�ANY � ___�,�
<br /> 31CsN,A'TURE �_ _ REGIS7ERED Y/ N FI?G CURRE� _ Y/N
<br /> /�cfdress C,__ _ ,,,_,� Llcense# C�_ �.,r�
<br /> NECH�hNICAL "� CtJMPANY ^� �,__,�,.�
<br /> iiGN�ATURE � � REGISTERED Y/ N FL•E:CURRE� Y/N
<br /> A+:Idress C�� �� Llcense# ��_ __r,�
<br /> )THEiFt ^�+ r C()MPANY _ • _,_Y„�
<br /> iif,atrli4'�Ui2E _� �,_„� RfGIS7Ei2Ep Y I N FI°E CURF2E� Y/N �
<br /> C_.
<br /> l���dress C_.___.,__.. � �...._� L.toense# C�„_ ' �..._.,J
<br /> ttt+i-t 9-I+t++if+Hi-Htti-F�V-I-h -li�t�H�tHi-4-f#itNitPtt+ f�hhti-H-t�htti-lii-H-Fi-N-lii�-fi+t-tHttt!-f�t+P�Ptt4
<br /> tES�DIEiNTIAt. Attech(2)Plot Plans;(2)sets of Buliding Plans;(1)set of E:nergy Forms; R-O-W Permif for new construction,
<br /> Minlmurn ten(10)warking days after submlttal date, Required anslte,Construction Plans,Stormwafer Pi�ns w/Silt Fence Installed,
<br /> Sanftary P=ac11ltles&1 dumpster;Slta Work f�ermlt far subdivislansl�arge proJects �
<br /> :OMt�fE:RC1AL Attach(��complete sets of Building Plans plus a Llfe Safety Page;{1)sek of Energy Form�.R-O-W Permlt far new cbnstructlon,
<br /> Minimum ten(10)working.days¢�fter submlttai daEe. R�equlred onslte,Constructlon P(ans,Starmwater Plans w/S11t Rence installE�d,
<br /> Sanit�ry�=acifities&1 dumps#er.Site Work�ermit for a!I ne7w pro)ects,All commerclal raquirements must meet compilance
<br /> ;lGN P�lcRMlT' Rttach(2)sets of Eng(neered Pl�tns. '
<br /> """«PFtOPERTY SURVEY requir�d far�II NEW construwtion, '
<br /> ¢7.IIII��f�3ZII3IIaSI7 ��L[II7:IID�I t17CCt8
<br /> �srect:{sans;
<br /> F�ill out application completely. �
<br /> C)�aner&Ccm#ractor si�n back of appllcation, notarized
<br /> i��ver$St5t)0,a Notica af Cammencement is required, {�;/G upgrades aver$7500)
<br /> fi�c{E;nt(faY the ctrntrac;#�r)or Power of Aftorney{for tM�owner}would be sc�meone with notarized lett�r frcam owner authorizing sama
<br /> ER.'('NE Ci)t�NTE:R P�:F�MITTtNG (Front of Application On(y) ,
<br /> �ofs ff shfngi�.s S�wers ServEce Upgr<�des Alt; FenGes(Plc�ttSurvey/Footage}
<br /> veway�s-Not over Counter if on public roadweys.,needs ROW �
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