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� Building Department <br /> � � � <br /> Date Rec9lved _ .��� Phone.Gontac�f,or Per�nittin �� ?�,4 - c't -�t 6S <br /> Owner's Name 2(� ►1� r� Owner Phone Numba �1 - 3 S <br /> Owner's Address ���. Owner Phone Numbe <br /> i <br /> Fee Simple Tltleholder Name Owner Phone Numbe <br /> i <br /> Fee Simple Titleholder Addreaa <br /> JOB ADDRESS �3 '�2 A s�,�i��e d R_ ZeP��Y�� ��S rL 3 3 sy LOT# �2 <br /> BUBDIVISION si�v-e2 C9 A�k. PARCEL ID# (�3-26-z/-d 2D -d O � - �/ �O <br /> � <br /> (OBTAINED FROM PR PERTY TAX NOTICE) <br /> WORK PROPOSED NEW ONSTR ADD/ALT � SION Q Q DEMOLISH <br /> � B INST LL 8 R�PAIR <br /> PROPOSED U8E Q SFR Q COMM Q OTFiER <br /> i TYPE OF CONSTRUCTION Q BLO K Q FRAME [� STEEL �] <br /> DESCRIPTION OF WORK h �AC R t T S.'Z2- Se Ze � `�0�/. C <br /> i <br /> BUILDIN(i SIZE �� SQ FOOTA(iE� HEI(iHT <br /> � <br /> BUILDINO $ �� VALUATION OF TOTAL CONSTRUCTION <br />, QELECTRICAL $ AMP S�RVICE Q PROO ESS ENEROY Q W.R.E.C. <br /> � <br /> i OPLUMBINO $ <br /> OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION �� �b�� <br /> OGAS Q ROO INC3 Q SPECIALTY CJ OTHER <br /> =1NISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO <br /> ` <br /> G f��a C' <br /> BUILDER ` COMPANY l.Ot„w-eS laoM�, CeN��2s' � n!�- <br /> 51GNATURE ` R8(31STERED Y/ N FE CURREA Y/N <br /> Address O 1�'O 1� O ��J /Z�A��cy 3 t-$7�' Licens # ��o .S(� � <br /> =LECTRICIAN � COMPANY <br /> 31GNATURE REQI3TERED Y/� N FE CURRE� Y/N <br /> Address Llcens # <br /> �LUMBER COMPANY <br /> 31GNATURE REOISTERED Y/ N FE CURREA Y/N <br /> Addreaa Llcens # � <br /> VIECHANICAL COMPANY <br /> iIGNATURE REGISTERED Y/ N fE CUitRE� Y/N <br /> � <br /> Addreas , Ucens # <br /> )YHER COMPANY <br /> 31GNATURE REOISTERED Y/ N FE CURRE� Y/N <br /> Address Llcens # <br /> tESIDENTIAL Attach(2)Plot Plans;(2)sets f Buliding Plans;(1)set of Energy Forms;R-O-W Permit for ew consUuctlon, <br /> Minlmutn ten(10)working day after submlttal date. Requlred onsite,ConstrucUon Plans, tormwater Plans w/Siit Fence Instailed, <br />--"`—`� " -'�Sanitary�Facliltles 8 1-dumpst r;Site Wo�ic Aermit,for s;:bdl�islonsAsrge proJects __ _ _ _ <br /> :OMMERCIAL Attach(3)wmplete sets of Buf ding Plans plus a Ufe Safety Page;(1)set of Energy Forms.R-O-W Permit tor new conswctlon. <br /> Minimum ten(10)working day after submittal date, Requlred onsite,ConstrucUon Plans, tormwater Plans w/Sllt Fence installed, <br /> Sanitary Facllities 8 1 dumpst r.Site Work Permit•for all new proJects,All commerclal requl ements must meet compllance <br /> iICiN PERMIT Attach(2)seta of Englneered lana. <br /> '•"PROPERTY SURVEY req red for all NEW construc0on. . <br /> )Irections: <br /> FIII out appllcatlon completely, , <br /> Owner&Contractor slgn back of applicatlon, otarized <br />' Ii over 52500,a Notice of Commencement s requlred. (AIC upgrades over E7500) <br /> ' Agent(for the contractor)or Power of Attome (for the owner)would tie someone with noterized letter fro owner authorizing same <br /> )VER THE COUNTER PERMITTINt3� - �(Front of Applica8on Only) <br /> teroofs Ii shingles Sewers Service Up rades A/C Fences(Plo�/SurveylFootage) <br /> Drlveways=Not over Counter If on public road ays..needs ROW•. <br />