|
�l�s�.�D ��•�,� G� 61�d1ngDepartment
<br /> "���
<br /> �n►�iGA , ,
<br /> Date Fieceiv�bd� �{
<br /> Phone Conta�ck for Permittin g 1� ���'�'"t -- "��� I
<br /> siu22�' �7SLLttI3� �L�ItiS.tl�i:
<br /> tlwn,��'s Nanse �l�ir�-i� �t�� Gi'►�� � Owner Phane Numuer ��'- 2•� �' ;y14�� ...��
<br /> Own�a�r's Addlress��o� -�or�T k}�v�i R� �� �� Owner Phon�Numk�ar �, ^�,]
<br /> Fee;aimple 1'itleho8der Name � �� _�� Owner PhonQ Wumber � � ^V�
<br /> Fee;:�Imple 1'ttlehoQder O�ddress �� .__ .._� .�_.._.�
<br /> ,I08�4DDREaiS C�WI}7 -��Rrk,�g� ���tii/I5 FG �5Y2 �,� LOT# ����
<br /> suex»vis�o��� �AhRyh:tl5 L�olon,.l C,�.�-q� �AR+c��.10#f(�,3-2b-�t• OC+�fJ-o'T�dJ � C�_O S,� _....__....�
<br /> (OBFAINEn FitOM iiROFEftTY TAX N07iCEj
<br /> �1IOR4�PROF�QSED e NSTAI}L5TR�.� REP�IR � SIGN [� C� DEMCtLISN
<br /> PROIF�OSED USE [� SFft (,� GOMM [r_ O'tHER ����� �T]
<br /> TYPF:OF CONSTRIJCTl�.1QJ � BLQCK (.� FE2ADAi� C� STEE� C�� C �^,�
<br /> �, ��.�
<br /> D�SI;IRIPTIO�NOF1NOf�K �I�JS'T/�/�,�'�'�! 3s�� d7� � 1/iNY�- 't'QAIG�„� �s
<br /> BUiL[U1NG S(i:E ��__ � !5Q FO�OTAGE CM.�� H�IGHT �,��)
<br /> 37:,iT�I:GA:i�Ta�I� R���1F� ,I]�:t:L�117
<br /> [_,/�SUII_D3NC3 ���,7{�!_��� VAL.UATIC>N bl=TQTAL CONSTRUCTIC)N
<br /> .
<br /> [_.�El.l=G7R1G;Al. $ '�'� AMI�SERVECE �'ROGRESS ENEl2C�Y
<br /> [� Q� W.R,E:.C,
<br /> [_�PLIIMBING r> � �
<br /> L j��'�,,�
<br /> [_�MEt;HANlCAl. $ VAL.UA'ffC�N Oi=MECHANICAL(NSTALI..�TiON �( ' �
<br /> � / �Q��
<br /> [_�GAB [� f200F1�1G [�� SPECIALTY � OTHER r � `
<br /> FINISHED FI.CyOR E;LEV�iTIONS �� � FLOOD ZC7NE AREA �YGS NO
<br /> tti-tttiH�tttttHtttFttt41-h tlttttttiitfti�fi-l-tifFttti tt�FFttti-tti-FftFHttttf-tti-tii-tttH-fiFt�t+tf+F�fti�4
<br /> i'',�.'j"f.'R-AM'�i ``°n��C�"ARd� � �___.._�
<br /> BUILIDER �6��5d$�'..7 C()MP'ANY �O4tJ�'S l��r?� C�"7�e2S �..�G
<br /> StGFlA,TURE �.___ _ RI3GISTERED. � �Y%�I�� FEE CUFtREA _ Y/N ��
<br /> �4�ddress �Q,�,�'o�C '75sl�'93C7R.�t�nk^10 �l. 32.�'7�.._� C.ican.se# �.��_ �Sa�}�'{1�r^,�
<br /> ELEC,1'RICIAIV �Y N C4?Mp'ANY ^ ^_��
<br /> StGN.ATURE �.�__ REiGISTERED Y/ N FEE CURRE� _ Y/N �~
<br /> _.�.__
<br /> ..._�
<br /> , ��,
<br /> ���ddress Llcense#
<br /> ----- -
<br /> pLUME!!ER ^r ^ CIJMPANY �� $ �_��
<br /> 31CaN,A�TUFZE ___ � REGIS7ERED Y/ N FI?E CURRE� � Y/N
<br /> /��;ldress C� _ �� 1_Icensa# ��_ ��,�
<br /> NECN�!►NICAI_ `.--- r C(7MPANY -��_ _��.�
<br /> i1GN�A'tURE [�.�_ REGISTEREp Y/ N FL=E CURRE� Y/N '
<br /> �_�
<br /> l�cldress C�--- � 1.lcense# ��_ ��.,
<br /> �7HEiFt �� C()MPANY _ • � ��
<br /> i1�N:4YUi2E [�W REGISTEREp Y/ N FlcE CURREA Y J N �
<br /> ��
<br /> ----- --- — �— � �.... �
<br /> lli�dress C�_w _ � l.Ccense# ��- -_..._..1 �
<br /> +i-f-H-Ff+i-fiilf+F�h1-H+t+t�41-F �i-tt�l-tf�htii�4�ht1-1-1-HitQ�i+h f�H-hH-lii-hfff4i-hl-l-H-F+t�Hf+#1li=t+iii-I-tf44fit•t
<br /> tESIDiEiNT�AI. A#tach(2)P►ot Plans;(2)sets of Bullding Plans;(1)set of E,nergy Forms;Ft-O-W permit for new Gonstruction, �
<br /> Nilnimum ten(10)working days z�ffer submittal date, Requ(red onsite,Construcfion Plans,Stormwater P1ans w/S11t Fence Insial�ed,
<br /> Sanitary i=acl!ltles&9 dumpster;Sfte Work F'srm{t for subdlvisions/iarge projects
<br /> :OMME:RCIA�. Attach(3)complete sets af Buflding Plans plus a Life Safety Page;{1)set of Energy h'orm�.R-O-W Permit Por new cbnstructlon.
<br /> Mlnimum ten(10)working days<�fter submittal date, R�aqulred onsite,Constructlon Plans,Starmwater Plans w/Sllt Fence Installed,_------
<br /> - �_Sani#�ry Facflfties_&1LL dumpster,_Site Wark_F'ermlt for all n�w proJecfs,A(I commercial requlrements must meet compitance _
<br /> rlGN P7=RMIT' Attach{2)sets of Englnaered Pl�ins. "-�� - '
<br /> _ _ -- �«i.►*p�OPER7Y SURVEY requlr�d for�II NEW constructlon.
<br /> �IIISI�xfS32tI�i1��33 �TI7�LI�� ]] q��8
<br /> �lrecl:l+ans;
<br /> F�ill out a��plfcaBon campletely. �
<br /> � t)�vner&Cantrac#or sic�n back of appl(cation, nc�tarized ,
<br /> 1�`�over$St51)d,a Noticr�of Commencement!s requicad. {A!C upgrades over$75d0)
<br /> �ct�snt{fo�ti�e ctsniractor}ar Pawer of Aftorney(for tho owner)would be sc�meane with notarized lefter from owner authoriz(ng same
<br /> �VER.'tHE Ct}I�NTER F�iF�MtTTlNG {Front of Appflcafion Oniy}
<br /> eroof;�ff shinglfas S�wers Service Upgr,�des Alt� Fonces(P1r�tlSurveytFootage}
<br /> { [►riveway�s-Not over Counter if on public roadways.,noeds R'OCN �
<br />
|