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<br /> aa3aao•onzo Clty of xephyrhips Pe�mlt Appticat'ton F�x-a:sasaooz�
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<br /> WaRK PRoa05ED (w`V!'�_,.rtEW CONSTR 8 ADD/ALT [� SIGN �„] � DEMOL49N
<br /> �f� tNSTAt.t, R�PAIR
<br /> AROPpSEo USE [� SFR [� C�MM [„� QTHER
<br /> I TYPE OF CONSTRUCT{ON [� BLOCK [� FkAME [�''r STE�I. [�
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<br /> DeScRiPnoN OF WORK -�. � � � v�;l �
<br /> BUtL[]!NG SlZE SQ F40TAGE� HBIONT
<br /> [_�Uti,DING S � �yt'� �'� VAt,UATiON OF T07AL CONSTRUGTION
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<br /> �ELECTRtCAt, 5 AMP SERVICE [� PROGRE55 ENERGY [� W,R.P.C�
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<br /> �MECHANlCAI s VAtUA7fON OF MEC3iANtCAt 1NSTALtATtOk " � ��"���`�%"' �
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<br /> F�KlSHED�GboR ELEvAndNS FLoOp 2dN6 YES NO ��� �,�� �j�
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<br /> 8Ul�oER OMP 4' '.:�
<br /> SIGNATURE - isi�RNo -- Y/N Ff0 GURR�11 Y/N
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<br /> SIGNATURH R�ae7easn Y 1 N I T ��Cvaa� Y J N
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<br /> MECHANICAL - COMPANY �-' [
<br /> SiGNA7i3i2E �Cl,-rEa� Y/N FPGCU�aEt� Y!N
<br /> Address Ucense� � �
<br /> I OTHER � COMPAt�1Y ��— �
<br /> SIQNA711RE RE¢�.YeaEo Y!N FEE CUAREA Y/N
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<br /> Addresa Liceatse�
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<br /> ftE,51UENTIAL Atleeh(2)Plol pleno,{2)ce�s of 6ulldinp Plans;{i)set o!EnerpY Fotms;R-4-W Fermit for nawconaWctivn,
<br /> Minimunt ten(t0)workln8 days aRer;ubmit4al date. Requlred onsl�e.Conawctlan Ptaos.Sto,Zrywste�Plans wt S{tt Fenoe(nsteited, �
<br /> Sanl[ary Fae111U6s&1 durnp,tet;Sila Wntk PeM7(t far 9ubtlivie'(o�eflarge pmJects
<br /> contM�ncia� AttaCh(2}complete a'ot9 oFBulltlinQ AlanB plus a Lifc 58(ely PpqB;{t)�Qt o!Enarpy Fortna.R•O-W Fkmrit tar nawconairc,ctton.
<br /> Mnlmum ton(10)working daya eRer su0tnikal tlata. Required onsile,CanaN,ctlon PWns.Stomivratar Fisne wt 51it Pertw inataued,
<br /> Sanitery F�ciillies&i duMpste�.51le Wark Pctmlt[nr g!!new proJecLs.A!I commerdel ccQuftamenta mus�rnae!camR�ianm
<br /> IGN PERMIT Attach(2}cets of 8npinaered Plans.
<br /> ""PROP�R7Y SURVEY requlred for�p NEW cOnsWction.
<br /> ircct�ons:
<br /> F11t out appiics6on aomplctaiy. I
<br /> OP.ner&CnnirIIcior etgn beek oi Hppllt�tian,nolarizetl �
<br /> navarS�5o0,uNo4ceorCommenwmontrmraqWmd. (n/Cupgmdosover575ou�
<br /> Agent(fnr tha canlrac[o�or ppw9t oFAtiomey(tpr the owner)v,outtl 6e:aameono wiiti notatized(atter Rvm ovmer autharizing sama
<br /> V�R THE CouNTER PERMITTiNG (caDy oi cqnlract roqul�ed�
<br /> eroat5 if shingics Sowers Sarvlce Upptades A/C Fences{Plad5urvoylFactape}
<br /> Ddvewnys-Not ovor Coqntor�t on pubttc roadways..ncods ROW
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