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....�,..���y....Hu�.���o���. <br /> ,.�a nri cA <br /> aate Ftecelver �� �� <br /> i Phone Gantack for Permittin �'d l 'Z(c, -- �{`RE�. , <br /> nrnxr� � <br /> 4wnea's NanZ YY1(��'t�'lt A U EC AS't� t�l.�,Z Own��r Fhone Number `t�l —`t�i`+f 3 — 7g`�g' � <br /> Own��'sAdc9r, ss[„� g �0��., r�"`�'�'_1 PkUf'._____� Ownf�rPhaneNumber � � .� <br /> i <br /> Fee;iimple 1'i�leho�der Name � Own�►r Phane Nucnber � � <br /> .... _.__..� <br /> � � � '�.� <br /> Fee:iimple 1'i lehoQder Address ' <br /> JOB A�DDRES' � O�'1 � /b�"�...¢_u�e=2�ePti�yG�t/�5 �L �3j��oC� LOT# � _.� <br /> SUBIDIVISIOfV �����I'�ZQ/��iR i1 i� PARC�L ID# ��'2.�0'.�1"QO l�'V` �3C7� - C�/�� �y...� <br /> (t}STAINED FI20N!nttOPERTY TAX HOTIGE} <br /> W�R.h PROF'�SED NEW CC)NSTR ADD/AL7 � SIGN �� CI DEMOLISH <br /> i INSTAI_!. �,� REPAIR <br /> PROIPOSED ISE [� SFR �� COMM � CiTHER [` �^� <br /> TYRf:QF CO STRtlCTl�N � e�.oc�: �� ��aM� 0 sTE�� C� C ....._._:� <br /> DESI;IRlPTtO�I OF 1NORK %'�1 S?'�!! �1 Z� 0� �p��, �f�'�yL �n(�,, w�� ! W qfk 6+aT��` �� <br /> 1a��� Feu <br /> BUILmING SI �E �4 :SQ FOOTAGE�� HEIOH7 �� � <br /> �RTSF� � T��t�G II�I(7 <br /> [�BUI�DING $ �� VAL,UATIQN 01=TOTAL CdNS'�RRJCTION <br /> [_�ELIc TRICAI. � � AMI'BERVICE � F'ROGRESS ENERGY CJ W,R.E:.C. <br /> i <br /> [_�PLUI BING ��^� �� <br /> [_�ME HANICAL $ � VAL.UATION OF MECHANIC�AL INSTALL.ATION � \ <br /> [_�GAS, [� ROOFING [� SPECIALTY [� O"THER ��� ���� r��� <br /> FINISNEE}FL I OR�I.EVATIC3N8 C� � �LOOD ZCtNE AREA �YES NA <br /> i-tti-tti-Ftiiit i !-Ft�tt ttiiiti�fiytttiitttti-tttttlti-tttfiiii�tttiit �-tti�tt-tttthti-ttttf�li-Ff�tt�f#FHi�f <br /> BUILIDER ( Ct?MP'ANY �,t+.�,.Q W �om�„ � T'�.jx,,. l.,t, `] <br /> SIGNA,1'URE ��i�/�._At�}TF10N�J GF� � RC�� REGISTEREO Y I N FEE CURR�� Y/'N <br /> � <br /> ,4ddress ( �Qt� �Ca7� �`�l�q 3 dR.�AN c� rt. '32�7g �lcense# �(�+G i.SQ$yl'7 �`.} <br /> El.EC:1'FtICIAW, � COMP"ANY � ,.� <br /> BiGt�ATURE I REGISTERED Y/ N FEE CURRET� Y/�N . <br /> ���ldress C � Llcense# C � <br /> PLUNlF3ER � COMAANY r �� <br /> SIGt+1.ATl1f2E ( f REGI3TERED `f/ N FEE CURRE� Y/N <br /> � �. � <br /> d�,��dress i C____ � �►cense# C �� <br /> MECE��aNICAI_I GOMPANY C�� _� <br /> �'�G������ REGISTERED � / N FEE CURREr Y/N <br /> A��dress I L____. � Llcense# C� ._.} <br /> C1THE:Ft I COMPANY C�+ . � <br /> 51GN,�IURE ; C� REGtSTERED 1 / N FEE CURREA <br /> � Y1N <br /> C <br /> A�idress r� � Lieensa# �� ...._.`� <br /> �ttttit++ti+F�rht�i+Ft ffif�tH�i-H�1i+hHiif+++tti�i-H-F+H+hFhHiti-hhhtl+H-H�i�F�lit+ii�tt�hH�i-h+f+tt9 <br /> 4ESIUIENTIAL Attach(2)Plot Pians;(2)sets of Bullding Plans;(1)set of Energy Forms;R-i�-W Permit for new cor�struction, <br /> Mlnlmam fen(10)working days after submittal date. Required onsite,Ccrostruction Plans,Stormwater Plans w!Siit Fence instailed, <br /> Sanitary Faclllties&1 dumpster;Site Work Permit for subdivisions/large pro)ec#s <br /> 10MMERC#A!.' Attach{3)complete sets of Buflding Plans pius a Llte Safety Page;{1)sot o#Energy Forms.R-t?-W_Perml�far�te�v ctsnsttuctlon.- <br /> __ ____ _Minlmtim fen_(10j-worklr.g-days-after-stjbmittat�ate��equlred ons�Cnnst�ucflon Pians,-Stormwater Pians w/S(It Fence Instailed, <br /> � Sanitary Faafllties&1 dumpster.Site Work f'ermit for ali n�w proJects.All comrnerclal requlrements must meet compliance <br /> �tGN P�ERM17', Attach(2}sets af Engfneered Plans. . <br /> ""*PFtOPERTY SURVEY requirod for atl NEW canstruction. ` <br /> �II11:TiI7 I� ����Q�2�� g <br /> 3lrect:i+ms: <br /> F�ill out appllcation completely, <br /> .,.�,..C1��cter:,�.Contractor.sfgn baok.of application,n�tarized <br /> `= It°�ver�$S►.5�00,_a NaHce.of.Cammencement Is requlred. {A!C upgrades over 57500� <br /> � i , - <br /> '; �1c�enf;�foir he'oonYractor)�prPower.of�At#orney(for the owner)would be sc�meone wlth notarized letter from owner authorizing same <br /> :l_.:..��:;'r:r l.�a�sil�'c`.. k'..A -.:.' � , <br /> }�;IER'FNE�Ct��NT�f2;p�:RM�nIFiG ��'; ' {�ront of Applacaf�fl�On(y} <br /> �e�oofs-if�sMingl�s��-�•-�- 5ewers = -�Service Upgr3des A/C Fences(PIoUSurvey/Footage) <br /> [irivewaS�s-Not over Counter If on pubiic roadways,.noeds ROW <br /> i <br />