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ourrurriy vcpzatttuerit <br /> Date fZeceivf:d �a"�'� <br /> �T� ' + Phone Gont�act f�o�r Permittln � f`� 'Z�? --�� � <br /> Ownea�'s Name St�,t,�r`"fh �t?a�� Own{er Phane Number �d 13-�?$p--b3�49 � <br /> Qwn��'s Ad�ress���St GrtRc�►�IR x�t,.tl� rL 33�Y2 � Own+�r Phone filumtter � .� <br /> Fee:ifmpte 1'ifleho9der Mame �� � Owrnar Phons Namher � � � <br /> Fee tilanple 7'itieha9dar Addtess �w .� i _� <br /> JOB�DDRESS Y65"! L�..��, ..,�z*.,�i�,�.���s �� 335�_...._ ��� �oT# ! S �—.� <br /> SUF3IDIVISIOIV W���/�ii�g pq�,,,r � PARC�L ID#�/5-�_2�"O�bQ-(�D�� --DD� �� <br /> {1�BTAINEQ FI20M pROP�RTY tAX NOTICE} <br /> WOR.M;PROPQSED NEW CC)NSTR ApD/AI.T � :�IGN C� CI DEMOLISH <br /> INSTA1.l. �� REPAIR <br /> PROIP()SED USE Q 5FR �� COMM � C)THER [� __"] <br /> TYPE=taf CflNSTR1JCTlf}N � BLQG3ti (� FRAME C� ��TEE� E� C �_._,.� <br /> DESt',lFtlPTIQ�N QF WC1RK STF# �.�a� 6� tN0 �o� l'�19�► -GIVCC �. <br /> ,....�...��.__ � _� � <br /> BUIL�ING SIZE C� � SQ FOOTAGE�� HIEIOMT C� ( <br /> �uczc�� �.0 �u�a <br />�I [��BUII.DING $ ��y��7� VAI.UATlON 01'TOTAL CQNS'TRUCTfON <br /> I <br />' [__�ELI;CTRICAL $ � AMI�5ERVICE [� F�ROGRESS ENERGY � W.R.E_.C. <br /> L_�PLUMBING C .—� <br /> MECHANICAL $ VAL,UATION Oi'MECHANICIAL INSTALL.ATION � <br /> �__� � �"" ���::>i" T <br /> 1� <br /> [_��GAS C] ROOFING [� SPECIALTY � OTH�R �Z �J�'(,' <br /> FIN(SF{f=0 F�OOR EIEVATlONS C�� fi�,00D ZtfNE Ai2EA �YES Nd <br /> -t-t-fi-hFri-fi-httfiiitt-Ffftfi ti--t��tittFht#ti-ittttittti�ti�tiitfitiitttiii-t #tHtfiii�t��FHi-i-FM-FFf-t�!•t <br /> BUILIDER .�'�d/ (`��`"'" �..� _� ..._�.� <br /> COM�'ANY t��.0 W�S_ I�Dfttl�: T�..f2: l..�. <br /> StGNA,i'URE f��2, qr,riF,oNy Gta�'ARo REGiSTEREp Y/�I3�� FEE CURREA Y/N ' <br /> � ,_._ <br /> ,4ddress �Pt� b�7� �`i��g R 3 p jL�AN n rt. '32�7$ Llcense# �(oG 1.S'4,$`fl? �.� <br /> EI.�C:1'f21GlAIV � CpMl�ANY <br /> StG�1ATURE REGiSTERED � Y J N FEE CURRE� Y I�N y� <br /> �� � <br /> t��ddress C _______ � �Icense# �, �� <br /> PLUN{!3{cR COMPANY � � �� <br /> SIGN,ATURE REGISTERED '(I N F[E CURRE� Y/N <br /> I��icfress C� � �lcense# � ._� <br /> MEGF��4W1CA!_ � GQMPANY r _� <br /> S1GEf,ATURE C _ REGI$TEREQ V I N P[E GURRE� Y/N <br /> ( � <br /> � � � � <br /> Nf�{�C@SS C � LIC6tiS$# �— .� <br /> � OTNEiFt � COMPANY • � <br /> SIGN,4T�JRE C REGISTERED 1'J IV FEE CURRE� Y I P) <br /> � � _._.�� <br /> A�iclress C� � �tcense# �� <br /> �i-t++it+i-hi+Wii-ti-H Hi-�+f�+fl-hFH-FH�f�4�FH1-F+FthFt�ti�++fii�f-hFFFhHii-hFi�Fi+ -H�f+i-f9 <br /> �ES4UIElJTIA4. Attach(2)Plot.Plans;{2)sets of Bu!lding Plans;{1 j set of Enargy Forms;R-t�-W Permik for new construction, <br /> Mlnlmum ten(10}working days after submittal dete. Required onsi#e,Canstrucfion Pians,Stormwater Pians w!Si(t Fence 3nstaNed, <br /> Sanitary Facllltles&1 dumpster;Slte Work Permit for subdlvlslons/large proJects <br /> _ �OMt,�El2CtAL Attach{3J complete sets of Suflding Plans pius a Life Safety Page;{'i)set o(Energy Farms.R-O-W Pecmlf tor new cAns#ntct(an.��__ ^ <br /> -� - - �— ---- �----Minimum-tetr{10}working-days-after-submitfai date. Required-onsite,Cc�nstruc#ion-Pians;Stormwater Pians wl;Siit-�'ence i"nstaited;"""` - <br /> Sanftary Fac(Iitles&1 dumpster.5ite Work F'ermR for all n�w pro)ects.All commerclal requlrements must meet compliance <br /> � itGN R�ERMEi' At#ach(2}sets of Engineered P1�ns. <br /> "*"'PROPERTY SURVEY requirod for ali NEW canstruction, <br /> 27.711IIII��C�II ����i7I�T 1 <br /> �Irect:taaras: <br /> F ill aut appllcation completely. <br /> U�aner&Contractor sign baok of appltcakion,nc>tarized <br /> � <br /> i��aver$:>500,a Natice of Commencemen#Is reyulrad. {A!C upgrades aver$T5Q0� <br /> ! ' F�c�ent(for the ccmtractor)pr Power of Attorney(for the owner)would be sc�meone with notarized letter from owner authorizing same <br /> �VER'tME Ct}UNTER P�tRM11TING {Front of AppAcatlon Only) <br /> teroof�,If shingles Sewers Service Upgrades A/C Fences(PIot/Survey/Footage) <br /> [iriv$ways-Not over Counker lf on public`�oa'd'ways.;noeds ROW � •� <br /> • _ . � ; <br />