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Building Department <br /> prvi cA <br /> Date Recelved � phone.¢ontact f,or Pa ittin g 1 ,� Z -r'j - �j�65 <br /> Owner's Name �-+-< i S 1��i A Owner Phone Numba $J3 -���- �O�� <br /> Owner's Address � 6 oZ� Q(�/�=�� I ,A Owner Phone Numbe I <br /> Fee Simple Tilleholder Name Owner Phone Numbe <br /> � <br /> Fee Simple Ti�leholder Addresa <br /> JOB ADDRE33 �9 7► j 0 Rl� �25� G,1RY ZeP�+,ey 1,i f IS F�- 3 3 SrSf LOT# � � <br /> 3UBDIVISION� D �G �Z� (� PARCEL ID# 6 2'Z�` 2'� - �2 0 - ��d�J - C1!�f� <br /> � (OBTAINEb FROM PR PERTY TAX NOTICrEj <br /> WORK PROPOSED NEW ONSTR ADD/ALT �] SION Q Q DEMOLISH <br /> � e INST LL 8 REPAIR �� <br /> PROP03ED USE Q SFR Q COMM �� OTHER <br /> TYPE OF CON3TRUCTION Q BLO K Q FRAME � STEEL Q <br /> DESCRIPTION,OFWORK �e-P�A e. l iD�L QC90�= �N�� 5�72 �S� �L �'Z2-`�3,7 <br /> � <br /> BUILDIN(3 SIZE SQ FOOTACiE� HEI(3HT <br /> BUILDINO $ 2�g�. Z VALUATION OF TOTAL CONSTRUCTION <br /> QELECTRICAL $ AMP SERVICE Q PROO ESS ENERC3Y Q W.R.E.C, <br /> OPLUMBINO $ <br /> [�MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION <br /> QGAS Q ROO ING Q SPECIALTY �� OTHER <br /> =1NISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO <br /> G C��tl �� <br /> aUtLDER ` �COMPANY �ow-eS l-�oM�e, CeNT�2s ' �/c, <br /> 51GNATURE REGISTERED Y/ N FE CURRE� Y/N <br /> Address � �Ol� o ��J 2�A��`" 3t"�7� Ucens # ��o .S� 1 <br /> ELECTRICIAN, COMPANY � <br /> 31GNATURE REOISTERBD Y/ N FE CURREA Y/N <br /> Address Llcens # <br /> �LUMBER � COMPANY <br /> 31GNATURE REOISTERED Y/ N FE CURRE� Y/N <br /> Addresa Licens # <br /> �1ECHANICAL , COMPANY , <br /> 31GNATURE REG�sTERED Y/ N FE CURRE� Y/N I <br /> Address Licens # <br /> )THER COMPANY <br /> 31C3NATURE REOISTHREO Y/.N Fe CURRE� Y/N <br /> Address Licena # <br /> tESIDENTIAL Attach(2)Plot Plans;(2)sets f Buliding Plans;(1)set of Energy Forms;R-O-W Permit for ew consUucUon, <br /> Minlmuin ten(10)working day after submittal date. Requlred onsite,ConstrucUon Plans, tormwater Plans wl Silt Fence instailed, � <br /> A Sanllary�FaG11Ues 81 duinpst r•,Site V11ork PeRnit;fur sutidivislons/Iar�sproJsots - -- --- - - --- — <br /> ' :OMMERCIAL Attach(3)complete sets of Hul ding Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new consWction. <br /> Minlmum ten(10)working day after submlttal date. Requlred onsite,Constructlon Plans, tormwater Plans w/Sllt Fence Installed, _ <br /> Sanitary Facllities 8 1 dumpst r.Site Work Permlt�for all new projects.All commercial requi ements must meet compllance <br /> iIC3N PERMIT Attach(2)sets of Engineered lans. , <br /> '"'•PROPERTY SURVEY req red for all NEW consUucUon. .. ', <br /> )irectlons: • , <br /> FIII out application completely. - <br /> Owner&Contractor slgn back of applicatlon, otarized <br /> If over S2S.00,a Notice of Commencement s requlred. (AlC upgrades over 57500) <br /> ' Agent(for the conhactor)or Power of Attome (for the owner)would be someone with notarized latter fro ovmar authorizing same <br /> )VER THE COUNTER PERMITTIN(i (Front of Appllcatlon Oniy) <br /> leroofs If shingles Seivers " "_Service.Up rades..NC Fences(PIoUSurvey/Footage) <br /> Drlveways=Not over Caunter If,on,publlo roed ay§;.needs ROW <br />