|
. . ' �-----._._ j ' 8uiiding Depe�#nent : .
<br /> I
<br /> � , I. •
<br /> Date Receive,d .f�— '��� ' �hone Contact far Permitfing •-�1� g�G. �.�`u��",� _
<br /> ' � . •, , . ,. ..
<br /> Owner's IVame r'�;t'�-c�yr ' j+7�"Ct.r' � _ - 4wtteT Phone'Nutitber. `F1 J 3 ' 7$�� '��3'-f '
<br /> . � . .. • ,
<br /> owner"s Address 3f� '� '. �'�'G . �',�"J��i!/s;,�'� 33t"'!2 ' OStirner Phane�lumbe�
<br /> . i • . - .
<br /> Fee Simple�7'itleholder Name �- � � � ` Ouvner Pitane Number
<br /> i. • . . . .
<br /> Fee SltripteTittehaider Addt�•ss�' 1 . . • ' ' ' ' • �
<br /> • JOB ADDRESS �I f 3 Zc� �r�' f J-✓'+�' .Z�rc. � r Lr�I J S �G �' ;3 3 r"'"�2 LOT-# �
<br /> 5U9DNISION.' • `nR.�'�'j �S7R'y►��� . PARC�I.ID# �2"2:�- 2/-a3A' �c�"-o38° •
<br /> �""' , , (08TAINEDEROMPitOPERTYTA%NOTIC�
<br /> WORKPROPOSED ' , ;; NEW GONSTR 'ADD/AL? SiGiV Q . MOVE •[� DEMOLtSH. , .
<br /> - . � � 1NSTALJ.. : e ..'REPAIR- � . . .
<br /> PRQP05ED USE - Q � SFR . ' �- COMM �] OTHEEi
<br /> ' TYPE OF G01+lSTRUCTIQlY Q � BLOCK � �], FRAME' � t Q - STEEL [� OTHER I�•.� ��
<br /> �ESCRIPTION O�WORK. ' •� /Gi .�•:� �'r �� 7• /�G � �/3S'"2/-<o - .
<br /> BUILDING SIZE ' • � SQ F407AC,E�� `,.,� � HEtG1,1T • . . , .
<br /> .
<br /> ' � BUILDiNG �$ �� � ��� r.- VALUATIOi�OF 70TAi.CONSTRUC7'fON �
<br /> ' . . , . , .�,. � . . . - , • , .
<br /> Q �ELECTRICAL $ • � : ' - AMFSERVtGE Q PRO�RESS�ENER�Y � � ������•
<br /> Q �'�l3tUlS3IV� � ,$ � � � .. . . . � ����� .
<br /> �' I• � .. , � , . .
<br /> Q MEGHAN,IGAL $ a : : . .. ' Vq�.UA3'iC1N,OFMEG�lAN1CALlNST�t.LATIOt'�! _
<br /> ,
<br /> � .
<br /> � . C.�.AS r, � �. R4QF,lNG- ,Q . SPECIALTY � flT!-iEl�- • , ,
<br /> .: , . ,.
<br /> FWISHED FLOOR ELEVA �ONS � ' � , FLOOD ZONE AREA _ [�YES` ' �[�NO '' • '
<br /> . . - - • .t � • � '
<br /> SU[LDER ' - � � `r •-f COMPANY ' l?��GiStOr"t ' i�oot StNic�.
<br /> SIC,NATURE � � /` RE�Is�REo Y/ N ., •FeE Cutt�NT: .Y 1 N
<br /> Addres.s 1�737 �r�.b,�l< R.J• Gltar..r+her�G.t -�'�3T�2 • � . . l3cense#. G�3G /2T�"t1G3 �
<br /> . � , , ,�,
<br /> ELE�TRiC1Atd.� . - . • :-`Ct1M�'AMf ' . • .
<br /> siGNA'I'I�RE ��isi��En . .� Y/ N �FE�cu�Nr - Y I i3 '
<br /> Addres� � ' ' _� � - t.icense# �� ` - �
<br /> . ,
<br /> � �
<br /> FLUMBER '; ' I . . ` . 't -. . , Ct�MPAl+IY � . - ' . -
<br /> 3IGNATURE• � � R�Gisr�t�o Y/ N FEE CURR�NT ' Y!N
<br /> - ' � �• ' • ` - ' �
<br /> . . { , , , : . _ • . �
<br /> Address 1 ' � • ` ` �UGeitse#
<br /> M�CPlANICAL ' � � ' �`� ' � COMPANY " • '., . •
<br /> • SI�NAi'Ul2E � . - = � �RE�x�Et� Y t t� , �GtT�REi�3' - Y!N . � . .
<br /> Address � � � - • • • � � ' _ .Liaense# I �
<br /> .._'�' .OTFIER ' • .. . � - . .. . " .
<br /> slCat+tAT1IRE �_'_. w.�._.. .._..._._..._.._._..__ ._ t�E6is�EttE� " Y/ N FE�GURREAis � • __ _
<br /> r
<br /> Address � ' � • I.icerise�
<br /> •�� I
<br /> RESID�NTIAL Altac�(2)Pla Plans;(2)sets of Bui[ding Pians'(�i)set af�nergy Forms;R 0=W�PermiYfor new constnuction,
<br /> _ . , °Mlc�tcnum.tea. ,0)wodcing,days after submittat da#e_ Re�quired ansife,Constructian Plans.Stamlwater Plans w%Sitl Fence lnskalled,
<br /> •� � Sanifar�F2tciii es 8�,9.diunps#e'r,Site Work Perinit for subc3ivisidns/large projea�s
<br /> COMMEFtC1AL• . ,Attar,�i.(3)co plete sets af Building Plans p1Us�a 'Llfe Safety Page;.(1)set-of�nergy Forms..R-�-W 1'ermit for new constructian.
<br /> . �Minli�um fen �14)wortcing days aftersubmitEat data. Rsquired a�isite,Gonstruction Plans,Starrnuvater Plans inr/'SUt FenGednsCalled�
<br /> Sanitary Pacil.Ges&1 dumpsfer.8i#e Work FermiE for atl neuv projec#s.A!I commercial requirements mttst meet cotnpliartca
<br /> ' SIGN PERMIT � Attaoh(2)se�of Eng[neered Plans. . _ - - ---- - -- . - -
<br /> . �"*P�ROPER SURVEIG required fQr a21:NEW.�onsiruc�on, - ' - .
<br />, birecti�ns; ' • l � . ' ' '
<br /> � �iit outappitcatian cor�pletely. . • • • • ' � ,. - '
<br /> Wmer�ConEracfor�ign b�tck+o'f apptica{ian,nofarized , •
<br /> If ove��25pD�a Noti e of Cotnmencement Is required, (A1C upgrades over$5000) - ,
<br /> "' Ageni{for tt�e cont�a�or}a�P er a�Attorqey(for the av»zer}would be someone witii notarized tet#er fcatn awnec atstizocizing same -
<br /> DVER THE GOUNTER PERMf7T1 G (Fror�k of Application Only) , '
<br /> .Reroats Sew�ers ServiceUpgrades AtC FenGes{Plo#tSarvayi�ootage) � -
<br /> UrivBways-IVa,t overfGounter f on public raadways,:needs R011V
<br /> GC';'_,., '2 y,;J.'.J::i!;'q, ..�` _ �^��r,.�e t, ,f,.
<br /> '°a'.�" ri �. ' _ ,., ' *�v_. 7 �
<br /> ,�'b��i :i�ii;, t,�f •.,�y � . � •;Uwi,l'1�;b f,:y!`•`��,_ . Yf';
<br /> , �. ... • . �(}1f�. . � :.�'��t�
<br /> . � �.. . -..;�. ...�. �. . .'1i{.. _ . ' ' �i: ,i.`f�:�,i<�i, � Y'"J �
<br /> . � .. . .: ' . . 't3..15�'a',`l;:L . �� .•�, , :�'�' .
<br />
|