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� � Building Department <br /> ON 'G1� <br /> qate ReaelvecY', �Z� �� ''` � Phone,Contact far.Pertnittin �� � 2. `� —�ra '..�'`� <br /> Owner'a.Name C.,C9 1 f�d 1� o rJ Owner Phone Numbe gj3' ��'2- �-939 <br /> ' � � <br /> Owner's Addre�ss sfl�� t?vmer Phone Numbe <br /> i �, <br /> Fee Slmple Tlttehotdar Name Owner Phone Numbe <br /> � � <br /> , <br /> , <br /> Fee Simpte Titieholder Addreaa <br /> JOB A����ss �J�S 3 3 ��e Z�.f'ht? �►:��S Fz 3 "'3 S �o�# R rQ � t <br /> suaonrtstor�� G;�r a�' ;! 5 pA�c�k ti� (l�2��21 -C7o 1 t�- aop -O g C.� <br /> , ' (OBTAINEb FROM PR PERTY TAX NOTICE) <br /> YUORK.PROPQSED NEW ONSTR ApDlALT �„� SIGN � Q DEMOLISH <br /> , e iNST LL 8 REPAiR <br /> PROPOSED USE � S�R [,� CtJMN1 [�] OTkiER <br /> TYPE qF CON37RUCYION [] BI.O K [� FRAME G� STEEL [� <br /> pESCRiPTiON,OF WQRK � �R/ 2 i -t t N�� i N L F`�'.�� i� I � D��- C �T`e <br /> BUILDlNC#3lZE C� 1 SQ FOQTAtiB . ; HEICiNT <br /> QBU#LDlN4 � �„�� VALUA710,N OF TflTAt CONSTRUC'TtON <br /> �ELEC1'RIGA{. $ AMP S�RVIC� Q PROQ ESS ENERQY Q W.R.E.C. <br /> QPLtlMBINO $ � /J J1{�O� <br /> ; � � �� <br /> �MECNAN{CAL $ VALURTI4N OF MECHANIGA�!(VSTALlATiON <br /> ��AS Q ROO lNCi Q SPECIAI.TY �,� OTHER <br /> =1NISHED FLOOR ELEVATIONS �'LOOD ZONE AREA [�YES NO <br /> � ��a � <br /> BUlLDER � ,gQ COMPAMI G C>r,�t-8S l�or�r�, L�,a`��!'`S 'r,j t, <br /> 51GNATURE ` �—✓"4- RE0137ERED Y/� N FE CURRE� Y I N <br /> Address O �Q X o '��+' J'�-�A�1�'{c> 3�-$7'�` L(cens # ��� � .S t7 �3 ��� <br /> �LECTRtC1AN COMPANY <br /> 31GNATURE RE(il$TERED Y/� N FE CURRE� Y/N <br /> Address Licens # �� ( <br /> �t�UMBER COMPANY <br /> #IGNATURE � RE0187ERED Y/ N FE CURRE� Y/N <br /> Addresa Licens # �— j <br /> d�CNANiCAI , COMPANY <br /> 31GNA7URE RE(31STERED Y/ N FE CURRE� Y/N <br /> Address , Licens # �� � <br /> �'THER COMPANY <br /> 31C3NATURE RE(iISTERED Y/ N FE CURRE� Y'I N <br /> Address I.icens # �� � <br /> 2ESIQENTtAL Attach{2}P►af Plans;{2)sets f 8ulldfng Plans;{1}set of Energy Forms;R-�-W Pertnit far ew constructlon, <br /> Minlmutn ten(10)wo►king day after submittal date. Requlred onsite,Cpnstruction Plans, tarmwater Plans w/Silt Fence Instailed, <br /> Sanitary�Facliltles&1 dumpst _r,Site Work Permit,f°r subdlvlslons/large proJects _� .___._ __ - � _ . ._ , <br /> `;OMMERCtAC Afta`cfi(3)cbrtipiete sefs of Bui ding Pians plus a!(fe Safety Page;('i)set of Energy Fatms.R•�-W Petmit far new conswction. <br /> Mlnimum ten(10)wo�king day after submittal date. Requlred onsite,Const�uctlon Plans, tarmwater Plans wl Sflt Fence Installed, <br /> Sanl#a�y Facltltles&1 dumpst r.Site Work ParmEt�far aN new pro�ects,Ali commeralai requl ements must meet campllance <br /> iIGN PEitMIT Attach(2)aets of Engineered lana. <br /> ""PROPER7Y SURVEY req Ired for all NEW canstructlan, , <br /> )Irections: <br /> FIl1 out appNcakion campletely. <br /> Owner&Cantractar sign back af appllcatlon, otarized <br /> Ii over S25Q0,a Notice oi Commencement s required. (A/G upgrades over 37500) <br /> ` Agent(far the contrac#or)or,Fower of,At#ome.(for#ite oin+ner}would be sameone wlth notarized lettar fro ovmer authoriz(ng same <br /> )VER THE COUNTER PERMITTIN(3 '(Front of Applicatlon Only) <br /> teroofs iI shEngles Sewers Se�vice Up rades A/G .� Fenaes(Plat/SurveylFoatags} <br /> Drlveways�Not over Counter"If on publfc roa.d ays,..needs ROW � <br />