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e»-�so-�Zo City of ZephyrhiNs Permit Appli�tion ���-�� <br /> e��ia��o�p��,� <br /> Dats Rmceivod Phone Conh3ct for Pe►mlti+n – <br /> o,�r�a� i o�P an�e N�m� `d1�3-�1�2�- <br /> o�ors aea►� . O3 f3`� a �`-o�s.�w��► <br /> Fee Simple Tftleholder Mame `3 Oumor Phone kumber � � <br /> Feo Slmple Titloholder Addros� VI.J ►""�e <br /> JOBADDRESS LOTi � <br /> SUBDMSION PA�EL ID� <br /> (oBrAYM�FRQm Pi�iS�ipx h'OQiCE) <br /> WORK PROPOSED � NEW CONSfR B ADD/ALT Q SIGN [� Q DEMOiJSH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SFR � COMM Q OTHER <br /> 7YPE OF COPISTRUCTION Q BLOCK Q FRAME Q STEEL Q <br /> oescwPnow oF wowc � C �10�'1 QO lA��' �� S�� c� �5r S�Y"C<< YC� C � �S�`S�-�.1 <br /> BUILDiP7G SI7F SQ FOOTACsE� HFJGHT �� � <br /> QBUtLDING g VALUATION OF TOTAL CONSTRUC710N <br /> QELECTRICAL $ AMP SERVICE Q PROC�tESS fNERGY Q W.R.E.C. <br /> QPLUMBING $ <br /> �MECHANICAL S���� VALUATION OF M7ECFWNICAL INSTALLATION l�'`��/� <br /> �r�' 4 <br /> Q(`,qS Q ROOFING Q SPECIALTY Q OTiiER ^ , �/�/'„�g <br /> oc <br /> FINISHED FLOOR ELEVATIONS FLOOD ZOPlE AREA QYES NO l:�W E <br /> + • �` �3�.-:� —_�� a-�r L^ . ... .,. <br /> 'SUILDER � CO�IPANY � <br /> g�C,{,�pnJ� REc�s�� Y/N �cttx�. Y!N <br /> Addrass Lieense ti�� <br /> ELECTRICIAPd COA4P/WY <br /> g�Gtiqyvy� REGISTEREO Y/N �cuRRE�. Y!A1 <br /> Addtess lJcense# <br /> PLUMBER � C�P� <br /> c,�q�pnp}� t�G�sTERm Y!N �curtRE�. Y/N <br /> Addrttss Licar�se ffi <br /> MECHANICAL ' CO�lPAAfY �\1��C' ` ��r 4 �I I��A.�Iv11� — <br /> S1G6VATURE aECIs7E� �!�—�r.E cusa�n Y!fl1: <br /> Addross �-C S 5 LieBrreeS <br /> OTHER COPdPAidY � <br /> SIGNATURE aEctsre�o Y/ N r�cuwte� Y/N <br /> Addross License a 1 <br /> OIA1111111FCBE11111A11Ai ! lOIIIE1911111liAtl9G16BLI81tYt181B11E19l111 <br /> RESiDENT1AL Attech(2)Plot Plens;(2)sets of Building Plens;(1)set of Enargy Forms:R-O-W Pennit far new cortsinx�on. <br /> Minirtsum ten(10)woriting days aRer submittal date. Requi2d onsite,Corw�avction PTans.Stortnv:�er Ftans vd SAt Fe�irt�. <br /> Sanitary Facilities&1 d�snpster,Sife Wo�tc Permit for sttbdiulsions/�ar�{e plaje� <br /> C09'�PAERGAL AttaCh(2)completa sets M BWlding Ptans plus o Lifcs SaPety Page:(1)seY o7 ErtelBY F�ms.R-O-W Pertnit fat�v conshudion. <br /> Minunum ten(70)wroridng days a8er submiffal date. RequSted atsite.Constnu�ioi�PIenB,Stnrmutetet FL�fs vef Sti!Fert�insteflcd, <br /> Sanqary fadiities&1 dumpscer.Site Wak Pemtit 9a all new Projects.A!I comma�+eia!roRuitemeMs must rtmet eomptia+ke <br /> SIGW PEHMIT Atterh(2)sets of Engineered Plarts. <br /> ""PROPERTY SURVEY required for all(VEW construdion. <br /> a `�u�.�tis.,��,v.<L,S' ���1� <br /> Dlreetlons: <br /> FIlI out appGcation completety. � <br /> pv�mer d,Contractvr sipn beck of appfi�tion,notarized <br /> If ovor$2500,a Notice of Commencemant Is requirod. (A!C upgrades ovor$76C0$ <br /> " Agerrt(f�the contrador)or Power of Attomey(for Uie ovmer�would be someone u9ifi rtoter¢ed lotter fiom awner aNha'¢tng seme <br /> ONER TNE COUtdTER PERMfTTiNG (copy of contrad required) <br /> Retoof^,it shfngles Sewers Senrice Upg2des NC Fences(Ptot/Survey�ootage) <br /> Driveways-Not over Counter if on pubNc roedvrays..rteeds ROW <br />