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Building beparlmen <br /> , ,�,�,� � �rv 'c:.f� <br /> I pate Rec�ived � i �� ; , � <br /> Phane Contact f.or Permittin �l '2 q - '�'j q�, � <br /> Owne�'s Plame �1 pl PI�A i j ner Phane Numbe 2� � - ��'l l'}2?2y <br /> Ctwner's�Address ��� J 1�T�.,,5't" Z,C�,Pk�Y�'+�i�,� wl...- T S� ner Phone Numbe �t 3 - 7 g 3 - '�3$'�� <br /> Fes Simp�fe Tidehalder Name �� � ner Phorte Numbe � � <br /> Fee Sim�sie Tittehoider Address �� � <br /> }� i <br /> JOBADO�RE�S T7 !�7- 1�Tti S�" Z,�p1.� ti;t�s �' 3 35y�' �o�r# i t <br /> � <br /> suBo�vf:��o� �ac�cs�2�'' F'r�s% �,�d PARCEL 1D# ,'-! - 2G��/-Oa � �- a 2�oo�- Q t 2 a <br /> (OBTAINED FROM PRbPERTY TAX NOTIGB) <br /> WORK F'120PQSED e NEW CONS?R 8 ADD/ALT � SIGN Q � Q DEMOl.lSH - . <br /> INSTAlL REPAIR � <br /> PROPOSED 4JSE Q SFR [� COMM [,,,� OTHER I <br /> 'IYPE OF CONB'i'Rt1GTidN [� BLO+�K �] FRAME �] STEEL Q <br /> RESCRtP'TIONQFWORK /ZeAt,�� :2 r.��:"t5 .St fS�x ��- JS'2.Zs'". 3 , . . <br /> _�.,_ <br /> I BUILDt1�lt"a StZE � � SQ F{}QTAt3E����� NEtGHT �_� . <br /> � <br /> BU}LD1NG $ j��� � �/ALUATION�F TOTAL.C NSTRt1CTION I <br /> . C) <br /> ��ELLCTRICAt, $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.G. . <br /> ��� <br /> . �PLUMBING �� : <br /> ��MECHANICAL �� VALUATlON OF MECHAN CAL.INSTALLATION ����� � � -. <br /> � � <br /> C�GAS [� ROaFING Q SPECIAL'TY C] OTHER, � � <br /> FINISHEC)FLOOF2 ELEVATIONS ��� F1.00D ZONE AREA [�YES ' NO - <br /> f^Hti-f�l-ht'tttt HHttt�ttFt't't� �- �' � G/� ��,c'� �-�' - <br /> BUIl.DE� �, NY C>w-eS_ �-�ar��,�CBN'T�e.�„� L,C.. <br /> SIGNATIIRE REGISTERED Y/ N FE CURRE� � Y f�N <br /> Addres� �'"C� t-�e�ti � t��. 1,,,���' L��-�R�{r.,,'�c� /�� �'z" '7�'' Llcens # ��c+�. � .S C} ��� <br /> �I.ECTRICtAN COMpANY <br /> SIGNATURE REGIS7ERED Y/ N FEE`CURRE� Y/N <br /> Addres� �� � Lkcense# �� � <br /> PE,UMB�R GQMPANY <br /> 51GNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Addres� � � Licens�# � � <br /> MECHAt�ECAL COMI?ANY 1 <br /> SIGNA7URE REGISTERED Y J N FEE CURRE� Y/N <br /> Address � { Llcens�# �— � <br /> OTHEFi COMPANY <br /> SIGNATURE REGtSTERED Y I N FE CURRE� Y J N <br /> Addres;s � � Llcens # � 1 <br /> ti-fti-Fi-It <br /> RESlDENTIA[. Attach{2)Plot Plans;(2}sets of Sullding Ptans;{1)set of Enetgy For s;R-O-W Permit for aw constructlon, <br /> Mlnimum ten;(10)wark6ng da�ys after submittai date. Raquired onsite,Canstructlon Plans, tormwater Plans w!Silt Fence insta(led, <br /> Sanikary:Fa�IllUes&1 dumpster,Site.Worlt Permit.for-subdivislons/lar e proJects � - - - ----- <br /> ' CC}MMEFtCI�i[. Attach{3�camplste sets of BeJtldtng Plans plus a E.Ife Safety Page;{9 sat of Energy Forms.R-C?-W Perm{t for new construcllon. _ <br /> Mtnimum ten(10)working da;ys after submiE#al date. F�equired onsite,Canstruction Pians;Sfurmwater Plans wJ SHt Fence instailed, ' <br /> Sanitary Facfl(ties&1 dumpster.Site Work Permit for all new pro)ects All commercial requi�ements must meet compllance <br /> SIGN A��2NltT Attach{2}sets of Englneered Plans. � <br /> •►RRpROPERTY SURVEY requlred for ali NEW consWction. � <br /> �� <br /> f�irecttoras: � <br /> Fill aut app8cation completely. I � _ <br /> Owner&Contracior sign back af appllcation,notarized � _ <br /> If over$2500,a Nottce of Commencement is requfred. (A!C upgrades over S7 00} � <br /> " Agent(for the contractor)or Power of Attomey(for the owner)would be someone wl notarized latter frorr�owner authorizing same <br /> OVER TFiE COUNTER PERMITt'It�G (Frorat of Applicatlon Oniy} ( <br /> R�roofs IY shingles Sewers Servfce U'pgrades A/C Fences(PIat/Survey/ ootage) � <br /> I( <br /> Drlveways-Not over Counter If on public roeidways„needs ROW I <br /> I <br /> E <br /> I <br /> � <br /> � <br />