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• � �-� � r ' Building Departmenf '
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<br /> Date lisceive,d • � ,�,�..—� • i � ' " � ���' ����
<br /> Phane Contact for Permitting `• l 3�
<br /> Owner's Name 1"/�'�i�LJ�� � JZ.-t�b.�,n S Qwner 1'hane Numbec �' �3'" 7g_8 — r 316
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<br /> awne�'s Address 3�43 �b � h'�?� ,Z�r � � �usmer Phone Numbe��M
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<br /> Fee Stmpie Tatiehaider Name �. ' ' ' Owner Phone Nurriber
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<br /> Fee Slmgte Tiftehatder Address' i ' � �
<br /> ��fla Aon�ss 3$�K g rt'{n� v� 2z,�I.yr�►�'I�s, �'� 3�S`,'�'Z • I.OT:� ,3"Z .
<br /> aik �/i// ' ' � PARCE�.ID#DZ " 26 -'�t -o� 8�0 -vovd v_0 3.Zo .
<br /> SUBUIVISION. • .. , tpBTAiNEDFRfldSPROPERTYTAXNOTlC� � �
<br /> WORK PRC)POSEp ' , ' NEW CONSTR ADDlAL7 •Q SIGN Q . MOVE [� DEMOLiSF� . ,
<br /> • e ! tNSTAlL e ��REPAlR • •
<br /> PRQPOSED USE . � t SFR , ' �- COMM Q OTHER ' •
<br /> TYPE UF Gt'liVS7RUCT101+1 Q ; Bt»OCK Q FRAME ' .Q STEEL Q OTHER(�� �i7
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<br /> �ESCRIPTION OF WORK, � �/rr/ p. �a.� ��da r •-( Jl�7' ' GG-�#' / .f Z?4• I 2 G - �.
<br /> BUILDING SIZE � ; SQ F007AC`aE�l�� ' HEIGHT �,_�
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<br /> ' Q BUILDING � y�� Q � , � VAI.UATION OF T07AL CONSTRUCTION .
<br /> Q ELECTRICAL �$ • �� '. AMP SERVICE Q PRt7GRE$S ENERfiY Q W.ft.E.C.
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<br /> Q FLUNiBiNG `$ I ' ' '''� � .
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<br /> Q AAECHA�i1CAL �$ , � . VA,[.tlATiC1N OF MEGHAN{CAL INS3�LiA"TfON '
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<br /> � • GAS r , , [� �, ROOFIi�I�- ,[� . SPECIAL3Y Q `4THE32- . .
<br /> FINISHED FLOOR ELEVA'T ONS FLOOp ZONE AREA. QY'ES [�NO '
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<br /> BUIt,DER ,,, ,�� ' �""„��-�.' ,s� , � ��L,J , COMPANY ����i t/tf.c/�tc�� � L�v rS
<br /> SIGNATURE °� � R�GIsrEFiEO Y/ IV " �FEECUR�NT .Y�/N
<br /> Address I I � . � � - . ..t3�cense# � � oO�t3 7 9 Y �
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<br /> ELE�'Ci21CfAt�t. � I . . . . -`GCiM�ANY .. .
<br /> stGNATIiRE � !i� ��is��n � .Y/ N . ���cuRReNr - Y/N .
<br /> Acidress. • ' � ` � . - t,{cense# C ' • �
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<br /> PLUMBER t` . � ; . 1 . �t . COMPANY - . ' -
<br /> SIONATURE• j �cisr�x�o Y/ N F�E CuttRENT ' �Y!N
<br /> Address � '' ' �LtGeiiSe#� �! - �
<br /> MECHAt+1iCAi. . � � � ' � Ct}MPANY " : : _
<br /> • SIGNA7URE � - : � REGISTERE� Y/ M , FEE CURREN3' - Y/N . ' .
<br /> Ac3dress � � • • ' � _ LiCense�# � . �
<br /> .� �-OT�IER' . , _. ..___... .----- _. Y � - � � . �
<br /> SIGNATUFtE � . ... �._ REGts7EREa ' Y/ i� FEE CURRENT tc( . __._.._
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<br /> Address � . . . . • � • - ' l.icerise# 1 �
<br /> RESlDENTIAL Attac�(2)Plo Plans;{2)sets of Building Plans;(1)set uf�nergy Farms;l2-0=W Permik for neinr constnuctlon,
<br /> .� Nt�nicnum.ten. „0}working,days afEer suhmlklal date. Requi�ed onsite,Canstructian P[ans.St�rmwater Plans wl 5(If Fence�nstat(ed,
<br /> � �� •• Sanit`ary.F�cili es&,1:dumps�er;Site Woric Perinik for snbdivlsicins/large projects
<br /> COMMERCIAL . Attach.(3)co plete sets of 8uilding Plans p{us a!_ife Safety Page;.{1)set of Energy Forms.R-Q-W PermIt for new wnstrucfian.
<br /> . Minisyium-ten '[4}wocking days a�ter submitta4 date. Required flnsiie,-�ons#rucE�on P1ans,Sfoimwatec Pia�s wl 3ift Feiice�mstatled,
<br /> Sanih�ary Facil4ties&1 dumpster.Site Wodc Permlt for ail new proJects.All commercial requirements mt(st meet cbmpliance
<br />, ' SIGN PERMIT Attach{2)sets of Engioeered Plat►s. ,
<br /> {"`**1'�20PEF2`'iY SUF�VEY required fpr atl:NEW.construc�an. -- • - .
<br /> Directions; . l� • , � . .
<br /> Fiii aut appiicafian cflmptetely: � � ' � " _ . . ,._ . .
<br /> Ouvner 8�Cantractor s'�ign b�ckfof application,notanized � • ' ' -
<br /> !f ovet�254Q,a Not�ce Qf Gs�inmencemeant is required. {AtC upgrades aver$5004) - "
<br /> " Agent(for ihe contraetor)or P�wer of Attorr�ey(for t,he ovu�er)would be someone with natarized letker from owner autharizing same -
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<br /> OVER itiE GOUNTER PEttMii3't � (Frocst af ApplscaBon Only} •
<br /> Reroofs Se�ers Service_Upgrades A1C Fences(P(otlSurvay/Footage) . .
<br /> Driveways-tVot aver�Gour�ter f on pubGc roadways.:needs FtOYit �
<br /> .. . . .f� .i. i1��7� 1`'_ ,:ir rSi` �i}.,'{'..
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<br /> i.4"�:.. . .� '.C. e � �.r �.:�� i, . 4::.�:�-?l''J1,,'J�'l�t�j���'``��t y.',.+". i.
<br /> ,ti�`i� ,_:,�;`. � .1.� � t 4�,�',y1.,�e ' ' . .,.s:4;�.",�"::.. . � .. .,.._ " `a�v�• I.' .
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