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��:�-f�°.�°z° Gity of Zephyrhiii� P�ermot Applic�tian Fax-813asaooz� .
<br /> � � Building Department
<br /> Date 13ecelved e� - �-= J ' I,
<br /> -: Phone�Conkact for P��mittln ,
<br /> Owaer's N�rrie ��� Il. � '� Own�r I�hone Numbea� � �3- 3 l a - 21 �
<br /> ��'5��� � �
<br /> OwneP's Address i`t' �L r 1 t , S tl-� l�wn�r Phone Nueeib�r
<br /> Feu Slen�le Title�9t�lder tda�e �_ � t2wner PF�ane Number �- � �',
<br /> Fee Simple T6tlehotder Add��$ `
<br /> sos aooR�s 3�f�- Ze h� f�� 4 t s � � 33 S�.� �.or� �_� �
<br /> ,
<br /> $tlBDiVISAOEi FAi�C��.lp�
<br /> (OB7AINED FROfN PROPERTY TAX NOTICE) �
<br /> WOiiK PROPC�S�U _NEW GONSYft' ADDlALT • C� S{G!V Q [� DEMQLlSH �
<br /> e. Ii�ST1�l 8 REPi41R
<br /> PROP03EDrUSE Q SFR� [] COMM � OTHER '
<br /> TYPE QF Cm�18'fi2UC'R0�1 � � BLOCK ' Q FRAME � STEEL Q �
<br /> ��scr���r�c��o�wo�x � d�r i vct e�( � ,�-��-e t� �e-F � ; !� - 1 `� � f�� c�� ��rc�' `
<br /> �UILDOPtG"�l�� '� � S4�FQOTA43E�. HEtB'ati'£.'C____��� ,
<br />') BUILbWG � 1 ,.1 ���-� VAlt1ATiON OF"i'OTAl:COi+iSTRtJCT-10N
<br /> 1
<br /> QELECTI2ICAL �_.� AM1P SERVICE [,�] PROGI2ESS ENERGY [� W.R.E,G. '
<br /> OPLUMBING $ ' �
<br /> ���� �
<br /> QMECHANICAL $ VA4UATION OF MECHHNICAL INSTALLATION
<br /> � �_�� -
<br /> � QGAS Q ROOFING Q SPECIALTY Q OTHER
<br /> FtNISNED F�OOR ELEVATIONS � � FL40D zONI�Ai2EA QYES. NO ,
<br /> i
<br /> BUILDE62 Gt�M6�A[dY ���'� ''�
<br /> $IGE1A'T1.aRE � REGISTEREd Y I �I -FEE CURREP Y/jd #
<br /> �
<br /> Addr�ass ' - , l:Icense#'� �
<br /> ELECTRICEAiV, : GOMIP�1@dY � '
<br /> BEGNAT�.PRE � REGISTERED Y t t� FEE Clif2RER ' `'Y 1 M1l ,
<br /> A�ddcesa license# �� . ' � ,
<br /> PLUflRB�Fi � CQMIP../,ANY
<br /> SIG[�'iURE' , ftEG1STEREd Y 1;N-, . .FEE GtiRREt� - Y-I(�! °
<br /> AtldP8a8 UCsnSB# � ��
<br /> M�CFiANf��' � � CONl�� '
<br /> Stt3N�►'Pt�62E ` t3�c�tsf�3� Y,I �] . FEE CU�tE�. y./N
<br /> _ ��
<br /> Addr��s - � � ° License# �� � �
<br /> OYHER , �COAAPr�V �� �
<br /> S1C3N�iT4J62E �'��'� ; - ' � ' ` 'i2EGlS'fEf2ED' Y J'{�l _. FEE Gt1RRER - Y l�1.
<br /> l4ddc�as , - - � UcenSe#'`�� �
<br /> r �
<br /> . ., _.,�: . ...,.�. ..,,,,.. ,�.ti,,. .,,.� -,.-.�y}a-.' ;� ii: a�._s;.�,:�. • "� . ., .., . . , . � .
<br /> RESIDENTI�;• °Attacti"(2),;Plot�°Rlans;�(2)sets�of:BuildingtPla�s;�(9)set'of'Ene'rgy�.Forrn's;R=Ck1n/^Perrnit far:new'ccnstruction,
<br /> <.,�Mtnimum��ten(4A)woriiin d� , .,. ' .
<br /> ' __. ,-, . �. ,'.'..,.> , 9:. .Ys�aitet;subiri{ttai date.;Requtreii onsite,�GonstiiicHon�,Plans,3tom�water Plans�wl S11t Fence inst�iiled,
<br /> �� SanikaryFac(IiUes.&r1v,dumpste_r,.�Sita�.iNorkhP'aermit•for.suti�ivislonsAaige,projects, .�`.�;� �
<br /> C�DMRAERCIAL Attach(3)�complete sets of`Buildfng Plans plus a Life S'afety�Page;�('9)set of En�rgy Forms.R-O-M/Permit for new construction.
<br /> Mlnlmum 4ert{10}working days after submlttal date. Ftequlred ansits,Construc#an Plans,Stormwater Plans wl Silt Fence installed,
<br /> Sanitary Facllides&1 dumpster.Site Work Permit fior all new<projects.All commercial requlrements.must meet cnmpllance �
<br /> SIGN PEFtMIT Attach"(2)sets of�Eng,i'rieeee.d,�Plans:;� � :� �.� , .
<br /> "*'PROPERIY SUFEVEY reqtelred.fot all NEW_consUvatlan.. .
<br /> ... __.........�_. .__..�._..... ,.,_�._ _ ..
<br /> �� �I�ecflmn�: � - � '
<br /> FRI out applicatfon completely.
<br /> ' Owner�Cantractor sign back of appllcaUon,notariaed �
<br /> if ov�r�2500,a Natice of Caenmenaem�nt is required. (AlC upgrades�v�r$T500)
<br /> �� -�.�.
<br /> '" /�qent{for the conttactorj or Power of Attoriiey(fot ttie owner}would he someone wiith no#arizad ietter from owner authoriaing same
<br /> fiVER THE C�UNTER:�?EttMITCING -- (Front ofi�Applicetion Only)- -
<br /> Reroafs 1#shingles Sewers Servic�Upgcades AtC Fences{PlotlSurveylFootage)
<br /> Drive�waya-nlat over Counter if on public raadways.,tieeds•ROW: .. . _ , ,�„ ,_ _, . _,
<br /> ` �; , ,. , >> .�.. ., ... � �
<br /> ' ! . .,i;.�.. ..;:j;.;;, ` � - .. �,�� , , , ., _. . , - ,
<br /> , � � � ' ., . ' 71 . ' �
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