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<br /> Building Deparfinent
<br /> ..�..— .__.__..!'�O�nl'1 G A
<br /> Date Ftecelvesd �z� M� �p�C�on�t�a�c�for Permittin �1"3 '2�'(0� ._ �'�6�'„
<br /> m�txxm�tn !i �'.[a�v�l�t;
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<br /> Own��'s Nante �PrlT�� �l2ri�(�t�6 �,,,, _ _._._" Owner Phone Numuer �� "� ` 'Z l,j i i�'T �
<br /> Ownaair's Addlress� 3gQ`�`� P�� /�R �_ ��� ��,�
<br /> 4wne�Phona Numt�er �, �
<br /> fee:aimple 1'itleho9der Name _ _�� Owner Phane Numtaer �� ��
<br /> Fee:i�lmpie 1'itleho�der�1rJdress C� _._ � .._...� _..r.]
<br /> JOB,�DDREaiS �„�O'�"�r r �'RIf, �R Z.P��lL y�'i j II S �t- 3�S'Y/'�. _M� LOT# �_�
<br /> susx>�v�sroi�� �7�_� �1���, ,� PAR�CI�LID#�/2-2��zi-�03�3 � 001op �- (ao50 �__.�
<br /> (OBTAINED Ft20M I�ROPERTY TAX NOTtCEj '
<br /> WQR6�i PRQF�4SE� NEW Ct}NS7R ADDIA�T �� SlGN �� C� DEMOLISH
<br /> 6i
<br /> INSTAI..L � REPAIR �
<br /> PROIF�OS�D 11SE 0 SFf2 J� COMM �� 4'THEF2 [�_____� ���
<br /> TYPE:OF COWSTRIJCTI�'JVJ [� BLQCK �_� FRAMi:: [� STE�L [� C r��,�
<br /> DESt,IRIPT10�1��F WORf4 �'�f�f� _�Ltl i ND►d Kl Un/�`�S Si u-�St?t �L (�'�O�' ^�.�
<br /> BUtL[pING Sie:E ��__ � ;yQ FO�JTAGE C^�.� H�IGHT ����
<br /> �i:� �:L�i�C.t ��i�X'i�qc�3S I ;GRt;[TFlfa
<br /> �-� ���"��N�' � �t ''��'(rj�� VALUATIC)N 01=TOTAL CONSTRUCTIC)N
<br /> �
<br /> �_�ELI�CTRl�.�,AL $ � AMi�SERV(CE � FsROCiRESS ENERCiY CJ W�R.E:.C.
<br /> [_.�PLiJMBlNG L .�� ?/�'7
<br /> � [��MEt:NANlCAL $ � VAL.UAT(t3N Oi=MECHAN(CAL INSTALi..�TION
<br /> � l� �
<br /> [_�GAS Q ROOFIiVG [_� SPECIALTY [� OTHER
<br /> , FIN(SNED F[.C�OR E;LEVA?'IONS (�� _� PLQOD ZCINE AREA �YGS NO
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<br /> 1-fi•tt-H�-t-tti-Fttti-httH-lt41-h ti�i�t-Itt t#11-H-hH-Ft p�i t�fi�F�tti-titlft�t-Ftt-ftittitt�tf�tif#tl�tti•ttF4�FH��
<br /> �'�'��-"r4`n-r�'�,E�AH�� .��D� .�.
<br /> ,�� ___..... _�..�..I
<br /> BUILIDER h^ " � � �J C()MF"ANY �oLv�S Nc�M�c�T�eR,S GL�
<br /> SIGNA�TUI2E ��'Lt.GI./ (/C�Cr RIcGISTEREp ��Y7—N� FEE CURRE� _ Y/N
<br /> ,4�ddress ��. _.r__ �_] (.Icense# �-!aG 1508�l! 7^___.,�
<br /> ELECI"RIGIAIV W Y C�UMP'ANY � ��_�,�
<br /> S1Ca1'1ATUI2E �.___ REEGISTERED Y/ N FEE CURRE� _ Y/N
<br /> �..__ _._.__ _ �.,
<br /> .
<br /> ,
<br /> a�+�dress C�__ �,__ Lfcen��# ,
<br /> pLUNIl;IER �~Yr CIJMPANY � - ' �,�
<br /> � 31GN�A'TURE �___ _ RE4ISTERED Y/ N FI3C CURRE� _ Y/N � r
<br /> Acldress C�__ � ...._.� I..Icense# C�- —..rl
<br /> NECHi!►NICAI_ �� Cf�MPANY � ���
<br /> i1GM�A��URE __ �I REGISTEREp Y/ N FLL CURRE� Y/N
<br /> I►�+:fdress C�. y � - Llcense# ��_ ' y..._.,�
<br /> �TME:Ft � r COMPANY _ • ^ _„�
<br /> iiGN�4YURE _ _,_,J REG�STEREp Y/ N FE9E GURRE� Y/N
<br /> C�.
<br /> lli�dress C._..w � ._� LIaense# ��_ �..._..i
<br /> t+-4�+1-t�P+htt+i�+Hitli�ii-l�4i-F �hF!-li-4i�t+i�9-F+t�{-k-hl+hQ�fft ttH+H-lif-�i-H-�t1�Fl-kttfitt+li-l-k#41t•!
<br /> tESIUIE:NTIAI. Attach(2)Plot Plans;(2)sets of Bulld(ng Plans;(1)set af Energy�orms;R-O-W Permlf for new construcfion,
<br /> Mlnimum ten(10}warking days aaffet submltfai date, Required onsite,Canstructlon Plans, Stormwater Plans w!Silt Fence Instalied,
<br /> Sanftary f=ac!!ltles&1 dumpster;S1te Work E'srmft fnr subdlvislansllarge pro)eots '
<br /> _OMME:RCIAL, Attach(�)complete sets of Building F'lans plus a Life Safety Page;{1a set of Energy Forms.R-O-W Permif for new cdnstructlon.
<br /> -- " "' -Minlm�am ten-(10)work�ng days��fter submlttal date, R�equlred onsite,Constructlon Pians,Stormwater Plans w/Slit Fence lnstalled, _,,�---
<br /> Sanl#ary F'acilltles&1 dumpster.Site Work�'e�in(t for a!l�n�w prcijec#s,Ali_com_merc(al requlrements must maet compliance —�"'~
<br /> ,lGN P'I°RMI1' Attach(�)sets of Englneered Pl��ns. � --- --- - � - -_--._-- _ -
<br /> "°""PFtOPERTY SURVEY requlr�d for�II NEW constructlon, - -
<br /> �SIS�:IDZ��II72Q9333 �Q��CL ']7�t� d�:[Id
<br /> �irect:l��ns:
<br /> F'ill out aKipiicatlon completely. �
<br /> C)�Mner&Ccmtractor slc�n back of appllcatlon,notarized ,
<br /> 11I�nver$�t5t70,a Nottc�of Comrttencemenf is required. (�IC upgrades aver$75d0}
<br /> �cicsnt(fov tlt8 ctrnttar,tnr}or Power of Attarney(for th�owner}would be sUmeane wifh notarizad iett�r from owner authorizing same
<br /> �VER.'�HE Ct�t�NTE�R P�iFvMiiTiNG (Front of Appiication On(y}
<br /> e�aaf�if shingl�:s Sewers SetvlCe Upgr��des Att.', Fences{PfaUSurveytFao#age}
<br /> [►rtveway�s-Not over Counter If on public roadways..n�eds ROW �
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