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oununty vesNaRrnCnt 1 <br /> I Ine/N�� <br />' Date Fteeelvf:d ..-Z.—j Phone Contact for Permiktin � ��� Z6"� -- � �� <br />, . <br /> owe.'s�N.amn�e ��•�A /' �/li ijlkN� � t7wrner P�hon�e Number �+��J �`'�3— 1 7 S� � <br />� � � .� ', <br />� Own�a•'s Adc�ress��2d� �'���'�d �l2 �� Own�3r Phane Number i <br /> Fee 3lmple 1'Itleholder Name �� �—_Y� Own��r Phone Numher � ,� <br /> Fee:ildnple 1'ItlehoVder Address C� � r _..� <br /> II JOBA�DDRESS 7�� �S►1�.g�y,��R �2P���iII� F'L 33�Yd ,_����� LOT# �`/ �.� <br /> I ---� <br />' su���v�s�o�v ���i a�2ePhr�+F►�its PA�c��ia# 35-ZS-2l-0050-o�-OZ�to <br />� <br /> {OBTAINED FItOM i�ROPERTY 7AX Hd�'iCE} <br /> ''; WORf�PROF�QSEQ N£W CpNSTR ADDlALT � .�IGN �� C� DEMOLtSN <br /> '� e INSTAI_L �� REPAlR <br /> ' PROIPOSED USE Q SFR � COMM [� UTNEFt � �,,,� <br /> TYPE:t?F CQNSTRIJCTleJN Q BLOC}� �� FRAM� � �TEE�. �� C i„_,.] <br /> j � � � �� <br /> I' DESCI�tIPTIO�NOFWORK .� STAlI ��0�p� (o�M� [. FeNc� �JiTh Z. CaAieS �� <br /> _,�..V+�NY <br /> �I BUIL[DING SIZE � � :Sq FOQTAGE�� �EIG�� 1 �� <br /> I <br /> �xc�� <br /> � <br /> [S�BU(LDINU � 7,��{' �d VALUATION 01=TOTAL CONS'TRUCTION <br /> I� [^��E�I�CTR1CAl. $ AMi�SERV(CE C� f'ROGRESS ENERCY � W,R.E:.C. <br /> j �._.._� <br /> IL__��LiJMBING $ <br /> � C_,.._ � � <br /> I [���MEGHANICAI. $ VAt,UAT(ON Oi=(t+tECHAN!{:AL INSTALL.ATION �� � <br /> [^�GAS [� RO{}F}NG �� SPECIAL7Y �] OTHER �� �C�r - <br /> �, FINIShIL=D FLOOR EI.EVATIONS (�� � FLOOD ZC1NE AREA �YES NO <br /> L <br /> �-rt�-r�-t�trm�m-rm�a -ttt tt�+r�t++t+tt+t�-�t�t <br /> BUILIpER � C()M�'ANY :w . I-�ome, f.T�',.(Z; L.l, � <br /> SiGNA,I'URE �p�' An�Tf�oN`�l GA�ARo REGIStEREp Y/ N FEE CURRE� Y/N <br /> �---� <br /> �4ddress �Po L3�,�. �'81�4 3 0�IA�t � �=t 3 zg?S l.fcsnse# L�c �s ogy/7 �_..� <br /> ELEC:TRICIAIV � COMA'ANY C� �,,,,� <br /> SIGN.ATURE REGISTERED =Y/ N FEE CURRE� Y/N <br /> ta+ddress C � l.Icense# �� �� <br /> PLUNI!#1=R COMPANY � �,� <br /> S1GN.ATURE RE(31STERED Y/ N F[E CURRE� Y/N . <br /> A+3�fress �,_w �� �icense# �� ____J <br /> MECNi�IVICAI_ � COMPANY � __,_�„� <br /> S1GrN�ATURE �. REGIS7ERED Y/ N 'FEE CURRE� Y/N <br /> Address �, � 4.lcertse# �,� ,.�,� <br /> OTMEiF! � COMPANY C� � _,,,� <br /> S1GN�0.T�JRE [� REGISTERED C'J N FEE CURREA Y/N <br /> {�l�df@Ss � � �.�G6tiS@$�` �� � <br /> -r�-H-�t�+rrw+�+++� -r�-ta�t+�tt+tt+t�t+tt+f-t+tt+�+�-i�+t++t++ttt��+-�-rtrrttt+�-t+tti+rt+ttt-�+r�-itt��+ro-�-t+� <br /> �ESIDIEt�71A1. Attach(2)Piot Plans;(2)se#s of Bulld(ng Plans;(1)set of Energy Forms;R-��-W Permit far new construction, <br /> Minlmum ten(40}working days after submittai date. Requlred onsite,Cnnsfructian Plans,Stormwafer Plans w!Silt Fence installed, <br /> Sanitary Faclfitles&1 dumpster,Sfte Work f'erm}t for subdivlsfanstlarge pra)ects <br /> :OM[JIEI2CIA�. Attach(3�completa sets of Building Plans plus a Life Safety Page;(1�sot of EneCgy_Forms.R-O-W Permit for na�N ebnstrucilon -- � <br /> - - ���inimum ten(40)worktng days a�fier sulaml#tal date. Requlred onsite,Constructlon Plans,Stormwater Plans w/Sllt Fence installed, <br /> Sanitary Facilifiss 8 9 dumps#er.Site Work F'ermlt for all naw pro)ects,All aommercial requirements must meet compiiance <br /> �IGM p'�RMl1' Atkach(2}sets of Englneered Pl�tns. <br /> wkMMP�op�RTY SURVEY requlrad for all NEW consUuction. <br /> I �II21�3�7�1II ���ZCt� 12C8 <br /> )frecS:l��t�s: <br /> �i F�ill ouf application completely. <br /> i Uwner&Contractor slgn back of appHcation,nc�tarized <br /> 1�1�aver$:�50d,a Notice of Commencement is requirad. (A/C upgrades over 57500� <br /> ' ��t�ent(far the cnntractor}or Powar of Attomey{for the owner}would be sc�meane with noterized letter from owner authorizing same <br /> )VER't'N1E Ct)UNTER P�:RMI7TiNG (Front of Appilcatlon Oniy) <br /> terfloP��1f shingles S�wers ServEoe tlpgrades AtC Fences(PIat/SurveytFaotage) <br /> [►riv�ewa��s-Not over Counter ff on publlc roadways.,noeds ROW <br />