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813��ao-oo2o CI�/Of Z@plly�I11IIS P@PI'Tllt AppIIC�t10� _„ „ - -. Fax 819-780-0021 <br /> 8u1lding Depatlmen#. .,� . . .: ��_ <br /> � . ' r <br /> Date Re�seiv�d Phone Can#act far.Permtttin ;; ., !(a3.4', " �' ` � `� �`d�C�� <br /> t?wrter's Namte �x' tA � �.� S Owner Phone Number � �� �S� <br /> Owner's Ad ress �`�1 � Owner Phone Number �r � <br /> Fee Slmple Itleholder Name �� � Owner Phone Number '� � <br /> ,'� ° •• <br />� Fee 3lmple Tltleholder Addr�ss ` I <br /> JOB ADDRE�S � LOT# �� �� <br /> SUBDIVISIO� �— � PARCEL ID# ' <br /> , (OBTAINED FROM PROPERTYTAX NOTICE) <br /> WORK PRO {33ED ° NEW WNSTR ApDtALT [� SIGN Q Q DEMOLtSii <br /> e. INSTALL 8 REPAIR ' <br /> PRQPOSED; SE Q SFR• Q COMM 'C,,.� OTHER <br /> TYPE OF CO STRUCTION - Q BLOCK " Q FRAME � STEEI, Q <br /> � . <br /> DESCFtiPTiO OF WORK ��Q e r�� � I�0�t �7 i <br /> SUILDING SI E'`�— �"SQ FOOTAGE C� HEI,GHT���,y� <br /> QBU GD�I�C' '� , � VALUATIOM1f'�CiF TOTAL CONSTRUCTION <br /> L_.. .J <br />� QE� CTRIGAl. � � AMP BERVIGE Q RROGRESS ENERGY [� W.R.E.C. <br /> QPL M81NG ' <br /> � �� I ��� <br /> �111 CHANICAL $ VAl.UATION OF MECHANICAI INSTALLATlQN ` � <br /> ��� � <br /> � <br /> QGAS [� RQOFING Q SPEGIAI.TY C� OTHER <br /> � <br /> FINISHED F OR ELEVATIQNS FI.00D zQNE AREA QYES. NO <br /> � BUI�DER COMPANY- <br /> I SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> ' — I <br /> Addres � ° L`icense# �� � �� <br /> E�ECTRtCI : � C�MPANY <br /> SIGNATURE � REGISTERED Y/ N FEE CURREk' " 'Y/N �� <br /> Axldre�s � � License#.� � , <br /> ' PLUMBER � � COlVOi?ANY , <br /> SIGNATURE" REGI$TERED Y./-N FEE CURRE� Y/N <br /> Address � .license# � � � <br /> NlEGMANICAl:' ,, COMP..�NY �. '�+t p �i EGt�i Lt��.- <br /> SIGNATURE � ' ' REGISTERED Y, N FEE CU E� Y/N <br /> Address �� ���� �� � ^ -�' �e� er y E � SS�F � Ucense# �G I�c�S'�1 0 � <br /> O'fHER • � ,CONIPANY -. <br /> SIGNATURE " � � � " REGIS7ERED �Y/ N.. FEE CURRE�' Y/N <br /> Addre� ' . . , lEcarise# � � <br /> RESiDEN71A� . Attacti"(2}.,Ftot Plans;{2)'sets:of:Buttilliig!Plai�s;(1)set of�Eriergy>Forir�s;F2=0=W Permit far new constructlon, � <br /> n :Mlnimum;ten�(:10)wworking;days�afte[:subriiiEtai date::Required onsite;Constnictlon�P-lansr Stonnwater Plans w/Sllt Fence instailed, <br /> Sanitary FaGlltles.&:;1 dumpste_r.,;Site�Warlc•.P-,ermit for su6divislo�s/large:projects :.� � ' • <br /> COMMERCI Attach{3)�comptefe sets`of"Bditiiing Pians plus a�I�fe Safety Page;{1}se#af Energy Forms.R t?-W Petmi#ior new cons#ns�on. <br /> Minimum ten(10)working days after submittal date. Required onsite,CanstrucUon Plans,Stortnwater Plans w/SUt Fence installed, <br /> Sanitary Faoilides&1 dumpster.Site Wor1c Permlt for all new�projects..All commercial requlrements must meet compllance � - <br /> SFGN PERMf Attmcti{2)"sefs"of'Englneeied:Platis.�,:. � �t. � <br /> •"`PROPERTY SURF/Elf requlred for all NEW.canstructlon. � . � <br /> Dlrectl4ns. . _� -- <br /> Ffll out a�plicadon completely. <br /> Owner&Contractar stgn back of appltcattan,notarized <br /> � If over a�S00,a Not[ce of Commencement i�requirad. {AtC upgrades over�7500) <br /> '" AgeM(fo the cantraotor)or PoYirer of Atkomey(fo�tlie owner)would be someone with�notarized letter from owner autha�izing same <br /> 4VER THE C UNTER PERMI'i'TTIN� -,--{Front at AppNcat�an�Only} - <br /> Reroofs if shi gles Sewers Service Upgrades A/C Fences(PlodSurvey/Foatage) <br /> Drivewa -Not over Counter if on pubfic roadwajrs..needs ROW <br />