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E vunumy vcspatu��etn <br /> _ , /Y7 tT/N"�~(.f4 <br /> p�at�e=ie�c�eiv��d� 7� Z L��f phone Cant�act t.�o,�r Permlttln � 13 Zb'� `�J � � <br /> Ownea�'s Name� t� �!� Gtwn�er Phone Number � <br /> R��t__Id__ � _ �i — � 7 <br /> Own�a�'s Adc9re'ss Owt��r Phane Nutnber , <br /> [ �z��. A�� sr � � __.� <br /> _. <br /> Fee;ilmple 7'ftlehaider Name �_' � Owrnsr Phane Number � � <br /> Fee aidnple i'itlehoVdet Addtess �� _ � `� <br /> � <br /> JOBA�pDRESS �Z�Z PARI��P.I2 �iT� �hi j��..3� `�r�iL L4T# � � .� <br /> SUBbIVISIOIV ' [L��►�a�N E/ei9tiT5� PARC�L ID#���j�,'�a-2/-��."�O-G1GOOt'`� S„a�3Q Y `,� <br /> {t�87AtNED F12QM PROAERTY tAX HdTtCE) <br /> WORW.PROF�03ED NSTAI�LSTR�� REPAIFt � ��IGN C� CI DEMOLISH <br /> PROIPCISED USE SFR �� COMM [ ,� C)THER [ �_�� <br /> TYPE:i�F CQN i TRUCTI�N BLOGK �� _ FRANI� �� �TE�� C� C ..rr.� <br /> DESt;lFCIPTIO�NQFWORK �P..P� �O_�t� uay�'�$ Si2-tr $t�, FL11S34� l�'L. 1�Go3 � , <br /> BUlL[DING SIZ� C� � :4p FOOTAGEC� HI�ICiHT �� � <br /> � <br /> a��c�:u��u.t�c u�� uu.�x��zzi�zr� <br /> [��BUILOING $ l J �Y3' .C� VAL.UATION QI=70TAL CONS'TRUCTlON <br />�� _ � '7 f'".M <br /> [_^�ELI:�TRICAL $ � AMI'SERVICE [� F'ROGREBS ENERC,Y � W.R.E.C. <br /> [__�PLUMBING $ � <br /> � ��� <br /> [_�MEC�ANICAI. $ VAL.UATION Of=MECHANIC:AL INSTALUITION � � <br /> f � <br /> � GAS I ROOFINQ S E 7Y <br /> L_� , O I� P CIAI. � OTH�R <br /> � FINIS�lGD FLO i R ELEUATtONS r� � �LOOD ZGNE AREA �YES NO <br /> L <br /> �-r�r�-r�-t�-rt+��tt�-r tmt��-t-rn rt�tt� �+t�-��;tt+++�+rtt�-t , <br /> ^ � � � �� <br /> BUILID�R ��-�. co �A�Y ��o w�e..5 �-�om T�e.�,, �.L, <br /> SIGNA�TURE ���, At�TTf►O��I �C1�� REC�(STERED =Y'/"N FEE CURRE� Y/N ' � <br /> —, _.._`� <br /> ,4ddress ��O QC►7� �$lg q 3 �?(2.�Ar1 � t=t, "�Z87$ Llcense# ���-1��'�Y!? <br /> I ELEC:1'ftlClA1V ' � COMP'ANY <br /> SlGttiiATUl2E REGISTERED � �Y I N FEE CURRG� Y/N ��� <br /> �� �� � <br /> 1a�ddreSS �_-- ��_�� LIC@ti58# �� r� <br /> PLUNI[34=R ' GOMPANY <br /> SIfiiF1,ATUf2E � REG�&TERED � '(J N FEE CURRE� Y/N '—�� <br /> �� �� <br /> l��ir,tress �� �� �Icense# �� �� <br /> MECN�A141CA!_ � COMPANY ` _� <br /> S1GFI�AT#JRE � �. REGISTERED Y/ N F[E CURRE� �[ Y!N �� <br /> A��cir9ss _ �ICSt1S6# �� _� <br /> � � r <br /> ; OTHEiFt COMPANY �� <br /> SiGN,4T�JRE C REGISTERED Y/ N FEE CURRE� Y I N <br /> �___� � <br /> A�iciress . �� � Lioense# �� � <br /> -H+Ht+i-�+++�+P-t�f-H �i�FfhhHi#H+fi-1�Fi-H�ffiii-F �fi�ff+h9 <br /> �ESII)IENTIAI. � Attach(2)Plot Plans;{2)sets of Bullding Plans;{1)set of Energy Forms;R-��-W Permlt far new construation, <br /> Minlmum ten(10)workEng days af#er submittaf date. Requlred onslte,Cnnsfructian Plans,Stormwafer Plans wJ Silt Fence instailed, <br /> Sanit�ry Facllities&1 dumpster;Site Work Permlk for subdlvlsions/large proJeats <br /> :OMtV4E12.C{AL Attach(3}compiete sets of Bufldfng P1ans pius a Lffe 8afety Fage;{4)set of Energy Farms.R-0-W Perrnft for new cbnstnlct(an. <br /> - Minlm«m ten(10}working days after stibml#tai date. Required onsite,Ccrostructlon-P-Ians,Stormwater Ptans wl,Slit Fence instaued, <br /> ; Sanitnry Facilitles&1 dumpster.Site Work F�ermft for all naw proJects,All commercial requlrements must meet compliance-ti- -- <br /> iiGN F��E2MJ7' �, Af#ach(2}sefs of Engtneared Pt��ns. <br /> "`""PFtOPER'1`Y SURVEY requirod for all NEW constructlon. <br /> �3TIIiIII217:7SJ1III ��Q�1�t�:Ia:��L� 1$d <br /> }ireci;i��ras: <br /> F�ill c�ut application oampletely. <br /> U�vner�Cantrackor sign back of appltcakion,nc�ta�lzed <br /> 1��over$;�5Q0,a tJotice of Cammenceme�rt Is requlred. {A!C upgrades aver ST5d0� <br /> ' �lgent(for the cnntrar,tor)or Power of Attorney(for the owner)would be scameone with notarized letter from owner authorizing same <br /> )VER'C�16 Ct}UNT�R P�:RMtfiTtNG � {Frant of Appiica#ion'Only) _ <br /> teroofs�if shingles 5ewers Servlce Upgrades A/C Fences(PIot/Survey/Footage) <br /> [►iiv�ewaS�s-Not over Counter if ori public roadways..noeds ROW <br /> � . . <br /> .. ., . , ... <br />