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� ouuu0ty vG}�c7rttttetit <br /> M"�Iv��"� <br /> p�x���a,c�n� � Inl.''i 1'Y L N F ��� � �� ]]� <br /> i Phone Gontact far Permittin � $�'3 �.6�i' �b <br /> Own�ea�`s Name ��m��+'GR'�ieR+'N� S"�pjC,p� 4wrner Phane Number 7��_�o3•`r-7037 � <br /> Own��'s Ad�ress��0�4� N�»,t�7 e N��an1�R� � Own�r Phone Numbet � .� <br /> Fee lSfmple 7'Itleholder Name �� „� Qwn+�r Phane Nurc�ber � � � <br />( Fee>I�»pie 1'!tlehoQdet Address � _„_ ` � <br /> I JOB A�DDRESS fO�QS /7'uN�in7 Qwf (�R �Z_��i„I�5 ML�i�S� LQT# O 3��.� <br /> i <br /> 5U6171VISION �1��/e,�, Q q`GS � pARC�L ID# Q�J`�o'�� "Q(,� �'D�l�[7(^J~� (°��D ,� <br /> {ABTAINED FI20M I�ROAERTY tAX NdTtCE} <br /> WOR.M PROPOSED e NEW CC)NSTR I`� ADD/ALT � .�IGN [� C� DEMOLISH <br /> INSTAI_l. REPAIR <br /> PROIP()SED USE [� �FR I� COMM � UTHER [� �] <br />( TYPE:t�F CQNISTRIJCT[ON Q B�OGIi �� FRAME �� vTEE� C� C ._�.� <br /> DESt.'IFtiPTiQ�N OF WORK �t4.L� � ��� �� LtNt'� si� �i ��L.�._� ��� <br /> BUIL[DING SlZE �� � SQ FOOTAGE C� HIElC`ak1T G � ' <br /> �ILt7:I73333� ��7�IIu.k:� <br /> [��BUIL�DING $ �� .�. 2� VAL.UATIQN 01=TOTAL CONS'TRUCTION <br /> [_��ELI:CTRIrAL $ AMI�SERVICE f�ROGR�SS ENERC,Y W.R.E_.C. <br /> � � �� � <br /> [__�PLIJ BING $ <br />'� _ <br /> � ����� <br /> , [__�MEC ANICAL $ VAL,UATION Of=MECHANIC�AL INSTALU�1"ION � <br /> � <br /> [_�GAS C] ROOFING [� SPECIALTY � OTHER <br /> FlN1St-IC'D FLOOR EC.EVATtONS � �LOOb ZGNE AREA �YES NO <br /> i-t-l-Fttf i-tttttftttit FtthFt t#�hft#-Htttifi-F ttii-1i�fi�tl-li-tittFN-f�ti-t <br /> _h_ � j ��� <br /> eun...��R co��A�Y �,o w�e� I�ome. Ti.+�h' ��1 <br /> S1GFiA,TURE ��Q, f,��T�'�tOi�1y „GFatW RO REGISTEREp �°`�Y'/�1�1 FEE CURFtE� Y 1 N <br /> ,4ddress �t� t3ox ?8 t�R 3 p�tta� ca r''t. 3Z�j7'$ Llcense# ��G 1�pgyl7 y`.� <br /> ELEC;1'f21CtAi4 w COMWANY � r, <br /> SIGh1ATURE REGISTERED Y J N fEH CURRE� � Y/h1 <br /> a��i�#ress �� �� Llcsnse# �� �J <br /> PLUN4t3{cit COMPANY � �� <br /> S1GN,ATURE REOISTERED �(/ N FEE CURRE� � Y/N � <br /> AM�dress CY. �� l.Icsnse# � r� <br /> MECti�44VICAl_ � COMPANY Cr�^--' —� <br /> S1GN�ATURE C . REGISTERE� Y/ N 'FEE CURRE� Y I N <br /> � L.__� <br /> � <br /> a1+iclress C�,_,__ � �Icense# � � <br /> OTHfiFt , COMPANY • �� <br /> 51GNt4T�JRE C RHC,I3TERED 1'J N FEE GURREh Y/N <br /> _....___� � <br /> li�iciress C� � L(cense# � � <br /> -f-t++it+i-1ii+W-ffitH Hi�hFl�+ff�f+�hFthFt+f++fi-H-F+f+I-H-H�t i-tt+t+9 <br /> 4ESll)IEfa71At. Attach(2)Piot Plans;{2)sets of 8uflding Plans;{1)set of�nergy Forms;R-��-W Permtt tor new c.anstruction, <br /> Minlmum ten(i 0)working days after submittaf date. Raquired anslte,Cunsfruetian Pians,3tormwater P1ans w/St(f Fence tnstalied, <br /> Sanitary Facllities&1 dumpster;Slte Work Permlt for subdivislans/large proJects <br /> _:CtMt�tE12CIR�:=�= Attach(3}ca.mptete-se�s-of Bultd�ng"Plans-ptus�a Ci;a Sa�t�r Page;��'i)set-of Energy Forins��F2=0=V�1-F'ermlt for�new constructian. <br /> Minimum ten{90}working days after submitEal date. Required onsite,Ctmstruation Plans,Stormwater Plans w!Silt Fence(nstalled, <br /> Sanitary Facilitles&1 dumpster.Site Work Permft for all n�w pro)ects,All comrnerclal requlremants must meet compliance <br /> itGN F�ERM17' Aftach{2}sets of Englneered Ptans. <br /> Fkk�p��p�RTY SURVEY requlrad for all NEW constructlon. <br /> �T2t2i2x�L]3:�I ��m��tl�� 7IIB <br /> )Irect:H�r�s: <br /> F�ill c,ut ap ilication completely. <br /> C)�vner&Conkractar sign baek of app!(cation,nc�t�rized <br /> 1tP�a�rer$:?500,a Notia�af Commencement is requlred. {A!G upgrades over 57500� <br /> ' F�clent(for kIlhe contractor)or Power of Attomey(for the owner)would be snmeone with notarized letter from owner authorizfng same <br /> )VER'tME C{}UNTE:R P�iRMtTTtN6 jFrant of Applicatlon Only} <br /> �eroofs,if shingles Sewers Service Upgrades A/C �ences(PIoUSurvey/Footage) <br /> Urivaway�s�Not over Counker If on pubiic roadways..noeds ROW <br /> I <br />