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' , ' � r'"'�—�-- ( ; Buildtng Depatfinent ,
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<br /> Date Re�eive,dt • 12 �+ � ��f � � Phone Contact for Permitting ���r 3 �7G..,, �;-�.•M3'Z(p,
<br /> Owner's Name /T+"r�r'� U� �Z , � Owner Phane"Nvmber, `�l/G � / -r`���3 '
<br /> Owner's Address ��Y �f �h f 2�.� 1�•�/ +'� 3� � 2 ' Uu'vner Phone�lumbet�� I
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<br /> �ee Sienple'Tektehalder Name �• � ' ' Owner Ptione Nutnber
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<br /> Eee Sit»pleTiUeholder Add� ss"� i •' ' � .
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<br /> JOBApDRESS ls y`2 ��� ��. /+�I+l C '3'�,r"`�2 ' �oT�� �.
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<br /> St7BDIViS�ON.� • Z J� .� l�w�-�c�c2�. • � PARCFIID# �'Z"ZG-LI -e'a�f4�oc+oc+a - ��t'{n .
<br /> , • ' : . � , - .(OBTAINED FftOM PitOPERIY 7AX NOTICE� • '
<br /> WdRK P12flPt}S�Q ' , ';. NEW GONSTEi ADDIAI.T Q SIGN [Q . MOVE •[� LIEMOLtSF1 , ,
<br /> ' e � INSTALL : � ..REPAIR� � • •
<br /> PROPOSED USE' - Q � SPR , �- GOMM � OTHER " '• •
<br /> ' TYPE OF COIUSTRUCTIQN � � BLOCK Q FRAME ' f� • STEEL. [� OTHER�—�-I
<br /> �ESCRiPTtON OF WOitK, ' ,�i . 6 .� tr J��a� • I��X 7 ° ,c'G �#� /��2?��.3`� �.
<br /> BUILDIttiFG SfZE. " 1 SQ POOTAGE�_„� ' HEIGHT � �.�
<br /> � ' Q BU.ILDING $., VALUATION OF TOTAL CONSTRUCTI4N �
<br /> i . . I �7 �- � � . , - - . , � , .
<br /> ! Q 'ELECTRICAI. $ •�� i • • AMP SBRViCE � PFit}�RESS•Et+tERGX � Q W.R.E.C.
<br /> � � PLUIU181iVG ' •$ i " . ... ` . � � ���1SfJ -
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<br /> � Q MEGfiAj�I1CAl.. $ � � ' VqLUA3iOt+t.OP MEC�3ANlCAL lNST�#.LATl01V
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<br /> i Q . �AS r, �..�� #, RQOF.tAi�- ,Q. . SPEGIALTY � °O7"l-lEl�- ' . ' -
<br /> i FtiViSHEp FLOOR E�EVAI'IONS ' _ ELOOD ZCtNE ARFA _ YES' h!O � •
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<br /> � BUti,DEFt , ' � '„� - � . �. tCOMPAt+IY + �t7tn/�a �G?v�C/�?t4.�. (�ov�s �
<br /> � Sl�NATURE `'-- ��'`.... �Gisr�Ea � Y! N .. ��cu�r .Y�/N '
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<br /> Addres.s �3 2�f .GJ. r'-c,�.i�'tw,�,-r /� ,�e �'d �33G3i!� . - . Li,cense#. .. CjDB�'g`'r �
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<br /> �LE�TR1CIAt�1.. . � . - • � ' `'`CCIM�A[+IY ' . . ,
<br /> C SIGNATI'llt� � � ��isi��n .�' Y/ N .-�E cuR�r - Y/N '
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<br /> � Adciress. - � ' _, . - lscense# ' -
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<br /> PLUMBER �;. ' � ' • . ,t . •r Gf�11�PANY s ' . -
<br /> 31GNATURE• ' REG�sTER�p Y/ N FEE GlJRRENT` ' Y 1 N
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<br /> Address f ' . � � . �. ' 'L(cense# �
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<br /> MECWANIOAL � ' ' � ' ' ' � COM�ANY " ' "° ,,
<br /> • SIGNATURE • � � � REGiS'f�REp Y/ N � , FEE Ct1R�tEN3 ' Y 1 fi! . . .
<br /> Address � � � � � • ' ' ' � . _License# �� 1
<br /> ._. 'OTHEIZ" ' • .. . • _ . •. . , • ' .
<br /> SiGNA'NR� ..—�_... _.i.,�. ..�'. __..._._.._.__ �� EtEetsTERED ' Y i It! FEE CtSRf2EN1' [c� . ____
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<br /> Address • � • • - . . • � ` -• ' Lioen'se#� •�� � i
<br /> RESIDENTtAL Attac�►(2}Pla Plans;(2j sefs of Buitding Plans;(1)set a��net�g}r Fotms;R 0-W•Pertttit'for neint constivction, �,
<br /> . . �Minimum,ten ,0)wocking,days after submiktat date. RequIred onsIte,Constructinn Plans.Startnwater Plans w%Sil�Fence instailed,
<br /> Sani�'!ry,�acill es 8.,1,dut�p��e"r,Sits Work perinit fnr subclivisitfnsAarge projecis•
<br /> COMMERCiAL• . ,Atta�,h.(3)co plete seFs of 8uilding Plans pl'us a L'tfe Safetj/Page;.(9}set•af Er�ecgy Fvrams.F2 O,-W�'ernut for,new construcHon.
<br /> . �Niinliimum ten ,10)working days aftersuhmttta!date. Required onsite,�onstruclion Plans,Starmwater Plans w/'Silt FenCe•insfalled,
<br /> . San'I�ary Facil ties&1 dumpster.8itg Work Permit for all new projecfs.AII commercial requirements mUst meet compliance
<br /> ' SlGN PEi2MiF At#auh(2}sat af Engineered Ptans. , - -- ' -----�-.. --.� -__-.., , _ __
<br /> . *'",'*P�OPER SUt�VEY required for aILNEW.�onsWc�ori, � � - • .
<br /> - Direct�dns: " • . � ' �
<br /> 1=it{Qut applicaUon co�ngletely. . • . • � � ' ' . .
<br /> OWner&Contractar�ign b�ck of applica6on,notarized ' ' � • '
<br /> If river$2508,a No6�Ce of Go�menaement is required. tAIC upgrades o�er�5dd0) ` - "
<br /> '" Agent{for ihe contraetor)ar P wer o�Aitarr�ey(for tha owner}would be someane vulth notarized(etter fram owner autharizing sam� -
<br /> OVER THE GOUTi7ER P�RMIiTI O (FronE o�Applica6on O�ty} -
<br /> ,Rer4ofs 5e�ess ServIceUpgrades A/C �ences{PlfltlSurueylFaatagej • .
<br /> Driveways�lY�oNover•�oiin#er f oti.putitic roadways.:needs RONV � �
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