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81�780-OQ20 Y
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<br /> �; BuNding Q�partment
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<br /> Date Recetved \'
<br /> .i� � P..hane Cantact for P�a�t�41e� —
<br /> Owner's Na I e. \ + �'v� Owner Phone Number ���I� 9 �3�
<br /> Owrner's AddFess '�� � c.., 1 C.— � � y Owoer Phone Number � �
<br /> Fee Sfmple 7ltleholder Name �- � Owner Phone Number �
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<br /> Fee Slmple Titleholder Address
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<br /> JOB ADDRE3S � �� � '�'�` r�'C'—'+ LOT# �
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<br /> SUBDtVIS10H �� _ � PARCE�iD# , .
<br /> (OBTAINED FROM PROPERTY TAX NOTICE)
<br /> VYORK PROPOSED ^NEw COtdSTR • ADDlA1.T Q S{G1V [� Q DEMOi.lSii
<br /> INSTAI,L 8 REPAIR
<br /> Pl20POSEp:��SE � SFR Q COMM � OTHEF2
<br /> TYPE OF CQNSTRUCTION [�` BLOCK " � �RAME �� BTEEC Q
<br /> DESCRIPTiON OF WORK � � 1 �t ' .G � U�'1 �{J �
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<br /> BUII.DiNG SiZE` ' SQ'FOOi'AGE�� HEIGHT=
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<br /> ��������'' � �� VAI.UATION.+JF TO`i'AL Ct3NS'i`R1:ICTiOT�t
<br /> �EI.�CTRICAI $ " AMP SERVtCE PF20GRESS ENERGY W.R.E.C.
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<br /> QPL�MBING � $ '� ��
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<br /> QM�GHRNICAL $ VALUATlO,N OF�MECHANICAL INBTRLLATION � �"
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<br /> Q . Q/ ROOFlNG Q SPECtALTY � OTHER �
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<br /> FIIVIBHED F��OOR ELEVA710NS FLOOp ZONE AREA QYES. NO
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<br /> �u��.�E� � �D. coMP�u�nr�� d�fi�'"`
<br /> SIGNATURE �C�„5 REGISTERED Y/ N FeE cuRrtEn Y/N " .
<br /> �ddres . Llcense# �� �
<br /> E�ECTRICtAN ��t , Ct}MPAi�tY
<br /> SIGNATURE� � � � REGISTERED Y/ N FEE CURRE�°` �Y/N"
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<br /> Addre' Ucense#,� �
<br /> 31GNATURE �, , _l, R t?MFAN p Y/ N FEE CURRen Y/N
<br /> Addre� ' License,# (. , ��
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<br /> �IIECHAAtlC„ �
<br /> SIGNAT �.""""� �� '�_� � GISTERED Y.../ N FEECURRE� X/�N
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<br /> Add ""I �� ', ' . ' Ucense# � �
<br /> OTHER • �� � .��CONlPAAIY,
<br /> SIGNATURE� "- - . " � ' ' REGISTERED � Y/ N.., FEE CURRE�' Y/N
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<br /> Addre$ti ', . Clcense# '
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<br /> RESIDENT - Attacti'(2);Pto#�.P,lans;h(2)sets•-of<BulldfngxPians;{1)sef'af=Enet�y=Forms;R-0=W;Reriqit for new coi�sUvct[on,
<br /> Minimum�tenn(10);working days after,;subrnittal�date::R'equired ansife;;ConstriicBon�Pl'ans;�Starmwater'Plans w/SilYFence instatied,
<br /> "���'SanilaryFacdllUes�&,1;dumpste,r,cSiteWo���Permitforsubdiyisions/large;projects . ' - '
<br /> COMMERCI�L Attach(3)�+oamptete sef's ofBtiilillog"Plans ptus a Ltfe$afety Page;(1}set of Energy Forms.Ft-O-W Perm3#for new construc�on.
<br /> Minimum ten(10)working days after submittal date. Requlred onsite,ConstrucNon Ptans,Starmwater Plans w/Silt Fence installed,
<br /> 8anitary FacillUes 8�1 dumpste�.Site Work Permit for all new,projects:All commercial requlrements must meet compllance
<br /> SlGN PERM T Attac�i{2)"sets of'Engltieered;F'laris.,_ � • �; -
<br /> ' ""•PROPERTY SURVEY required for a0 NEW construction.
<br /> Dlractions: �� - � . '
<br /> FIII out 2pplicatlon wmpletely.
<br /> Owner&�Contractor sign back of appltcadon,notarizad
<br /> If cver�2500,a Natice of Commencement!s reqaired. {AtC upgrades over;7500}
<br /> " Agent(far the conVactor)or Power of Attomey'(for tFie owner)would be someone with notarized letter from owner authorizing same
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<br /> DVER 7'HE GOtlNTER.PERMITTING-- •- (Front af-Appllcation Only} -
<br /> Reroafs if sh ngles Sewers Service Upgrades A/C Fences(PIoUSurvey/Faotage) ,
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<br /> Drivewt�ya-Not aver Gounter tf on publEa roadways..need`s ROW
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