|
• � � � ( Buildtng Dapar#ment ; . .
<br /> I
<br /> � . • 1.
<br /> Date ReFeive,d` , ( � f ,��( �" � Rhone Contact for Permitting
<br /> ..$t3 S'trv, ,�,,,:''i32jo .
<br /> � . • . ..
<br /> Owner's Name �r! C tl K"'�- ��t . Owner Phone Ncimber ��!� ' ?�'S$ •. c�o 3+t� -
<br /> . � ., . .. .
<br /> Owner`s Address S^'AZ. N �.��rr+f t.f�"Zc,jt+�rr{�,��I r j F� 33S'!Z ' Ouirner Pttone l+Iumbei
<br /> : .i • .
<br /> Fee Simple'Tifieholder Name �- � � ` Owne�Phone Number
<br /> • �• ' ' � . . . , .
<br /> Fea Sinipte Tif[ehotder Addi$ss� 1 ' - �
<br /> zg -c.�1,,�.,,,,, c.� .2,�p�J'r b�'(1 s, k� 3 3's"'N 2 • 40T�# •Z,.� •
<br /> � JOH AQD$ESS � � `-""l .
<br /> . , ;� � �
<br /> 5UBOIVISION.� • �w ' waod r"��+�•�� • � PARCEL I�# !o-'�:G��'"Z i -��2:0 ..ooca�v - a Zs"'� •
<br /> . . . .(dBFARNEd FROM F�tdPERIY TAX NOt3G�
<br /> WOFtK PROPOS�p ' , ;: NEW GONSTFt ADDIAL.T •Q SIGN •[� . MOVE •CJ DEMOLtSt� , .
<br /> - e I tNSTALL - . � '•REPAlR- . . . .
<br /> PROPOSED USE . Q � 8FR , [�- COMM Q ���1� ' .
<br /> ' TYPE OF GONS'IRUCTi4�1V � � BLOGK [�, FRAME' '�,Q • STEEL. Q OTHER I— �— •.�� —�
<br /> DESCRIPTION O�WORK, ' �G�D� G?c«✓a�.c, (�e r •q'.X �I. ' FG '�'` . - .
<br /> BUII.bING SIZE � � SQ FOOTACtiE� �� ' HHICNT • -
<br /> .
<br /> ' Q BUILDING . $., ��� 7 cr, p o , �VALUAI'ION OF TOTAL CONSTRUCT(47N _ . � :
<br /> Q 'ELECTRiCAL ($� : _ '�, AMP SERVtCE . � PR06RESS�ENERGY • Q �•R��.�•
<br /> � i• ' �
<br /> � P�utiitBlNG ` � � �-�'� . , . �j� � �� -
<br /> �� . . -rc . .
<br /> Q MEG!-iA�liGAt. $, � � ; - .. .. � �/A1-UATE£7I�l.�}F MEGHA11tIGAL(NST�1l.tATlON .
<br /> � .
<br /> � • GAS r, � �, ROOF,tN�- ��. . SP�CSALTY � `OT!-IEE�• ` , ,
<br /> FIMSHED FLOOR ELEVAT ONS � ' . FLOOD ZON�.AREA , QYES` � r0N0 • '
<br /> . . ' ' •F ' ' . • '
<br /> •� .�� • .. .-. ' !
<br /> BUiLDEii , . - ""9� / t � COMPAMt , �r'�G t 51 d u� �¢,se" �-+c.r+llrc.�t, .
<br /> SIGNATURE ���Isr�En Y/ N � '�cuR�rrr .Y�l N
<br /> � �Address /3T3� �t-o�b,'t-� 'r31,.d- G 1�.,r-w��.•-,F t�.337& � . 1 . . t.tr.�nse�.� � G,�L'`"z�"g 1 ta 3
<br /> .,
<br /> . ,� � , ,
<br /> E[.E�:'1'ttiClAt+i.� . • . ' ''`C�MF�AHY� ' . • . .
<br /> SIGNATUFtE � tiE�isT�Ren . . .'� .Y/ N . '�E cuR�Nr - Y!ht '
<br /> Adiires� � ' � ' � � - t3cense# C ' - �� E
<br /> . , ,
<br /> i . ' . ,. . -
<br /> P1.EIMBEFt ' '' . , � . ' ' *c . . C�}MPANY �
<br /> 81GNATURE� ' F2EGIs7E�tEo Y/ N FEE cuRRENT ' �Y/N
<br /> Address I � ' '' �l1Geilse# � �
<br /> M�GWAHIGAL � ' ' � COMPANY " ' .: "
<br /> • SiCaNATURE � � � � � REGisi`�t7ED Y 1 � . FEE CllRREN� ` Y t N . � . .
<br /> Address � ( � - - - � ' ' , . .l.iaense# � �
<br /> '_ OTHEf� . , " - ... . . . - ._ � . ' .
<br /> SiGNA'i'IICiE �_... _.�.�_. _.�.._.._.._._.—..__ ' teEc�lsT�REu ' Y! E+l FEEcuRFtEtit' . __ _
<br /> • � . - - . • , , . • � �
<br /> Address ' License#
<br /> FtESID�NTIAL Attac�(2)Plo Plans;(2)sets of Bui[ding Plans;(1)set of�nergy Forms;R O�W�Permitfor nein►constnuotion,
<br /> . . °N1lntmum_ten ,0)working,days after svbmi#tal da#e. Requ'ued onsite,ConstrucE[an Ptans,Starmwater Plans w!Sflt Fence instailad,
<br /> •� •• Sanita�.FaciO es&,7:dut�tp5#e"r,8ite Work Pemtit{or sukrdi�isitins/iarc�e pro)ecfs
<br /> COMM�FtC1AL . ,Aitac�i.(3)ica plete sets af 8uilding Plans plUs�a Life Safely Page;.(1)set�oF Energy For.ms.Ft•Q-W�'emut for new canstruaGan.
<br /> , �Mirili�um ten 0}working days after subcttitta�date. Required a�isite,GQnstruction Pians,Stotrawater Plans wCsltt Fence�InstaUed,
<br /> __ _ Sani�ary Faail'ties 8�1 dumpster.8ite Work Permit for ali new prajecfs.All commerciat reqnirements mdst mee#compliance
<br /> ' SIGN PERMIT Atkaoh(2)set�of Engineered Flans. • , - - - � .___ _ ____�_ __ �
<br /> '";`*P�OPER SUt�VEY requiced fctr a11:NE111t.�onstruct�on, � - ' - .
<br /> Directians: " . I � � . ' '
<br /> �ili outapplica(tan co�nple#ely. . - . ' • - - -
<br /> Ovuner 8�Contractar$ign b�cktof application,notadzed - ' ' .
<br /> If dver�25qQ a Natil�e of Go�nmoncem�nt is required. (AIC upgrades over$5000) - - . ,.
<br /> ** Agent(for the'con#ra�tor)o�P wer o[Attr�rtaey(far the owt�er}wauld be someone wlth nofarized letfer from ovuner authorizing same -
<br /> OYER THE COUNI'ER I'ERMITTI G (Frorat of Application Only) , '
<br /> Reroofs Sev+�ers SecvIce Upgrades A!C Fences{PIotlSarvayl�aatage) • .
<br /> oriveways-Not over�ounter f on pubiic roadways.:need5 ROVN -�
<br /> �i_�.�i.�'r . -
<br /> i , :;' ... ,7v,�•y,7i�" ;i�;ir7 %:4 t '.-ry ' + ' 3��:;.;',Ii.. :�:A7'ti� 'ti* .
<br /> • ,..- ;jy. ..:... ,�i _. ,;F'_. '#,� - y - • . `�`�` ;'1't: . .'1i.�'„�7: r ' .. ':�- .
<br /> � 'y� ,. t . � -J' . . . _ � (�' , ,
<br /> . _ �!° ... ,.,,. , .,'. ��.; r". `.g,
<br /> ' . ,.:`ti�... „ ., .... ,.. ''�, ' .
<br />
|