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C,�iY c�`.�?���1�5«....�•'"'��" ._....._ ...� .,__. <br /> Bu ding Department <br /> � • r� � <br /> Date Received <br /> Phone Cantact ior Permtttin <br /> I <br /> Owner`s Nan�e Owner Phone Nutnber drt - S - � � I <br /> Own�r's Address ���'"� / V i r'1',�,�a nl l.�9!-}?� � Ownar Phene Numbe� � � � <br /> Fee 3imple Titleholder Name I �,� i)wner Phone Numbsr � � <br /> Fee 5fmpis Tttlehonder Address �� � <br /> JOB/lODRESS +' �a 2 l.pT# `�2.___. I', <br /> SUBiDtV151UN C �i �U���j�� PARCEI.ip# -'7..6- 2 '�-2 - OC"r p� - (�ZZC7 <br /> (OBTRINED FI20M PROAERTY TAX NOTlGE) <br /> WORFC FF20POSEU NEW CLINstR ADDtAtT � SIGN � � t}EMOi.ISH <br /> e INSTAI.L B REPAIFI <br /> PROt�OSED USE � SFR � Gt3N1M � OTHER <br /> TYPE:OF CONSTRIJCTtON Q BLOCM; �] FRAM� � STEEI. [�] �' � <br /> OESC�tIPT10N OF WORK 1-/�STA// /�' � c9� ` N���'(� V i N L �E� t`7Z� � C�aA7 <br /> SUIt�mIN{3 SlZE � . � 3Q FOQTAtiE� HEtGFiT �� <br /> � <br /> ����L�i�� � VALUATION O�TOTAL CONSTRUCT(UN <br /> �� � g 00 <br /> ���.�cra�cA� � � a�n s��v�c� � �Ro�a�ss Er���cr Q w.�.�.c. <br /> ��PLUMBlNG ($� � <br /> C_�MEChAN1CAS. i� VAl�tlAslON 4F MECHANI�AL INSxALLATlQN .� � � ��i� <br /> [�GAS [� ROOFING � SPEClALTI C� OTHER <br /> FINISFiED FIOOR�LEVATIONS (��� �LO00 20NE AREA QY�S NO <br /> L <br /> � ��� � <br /> eu����R � � coM�Ar�Y 1 CL-o weS I�om�C„�,cvT�, �.1,� � <br /> SIGNATURE � A�rr�,oray G�t�ca R�G1sTEttEd Y/ N���EeCURr�n�'�Y%,,��N�T <br /> ,�dd�ess �o j3o X ?`�3 t�tR 3 t3�tt�►�+tdc� r 32�t !�.?S �.�oense# CtoG 1St�$Yl?.,__._.,..# <br /> ELEGTRlCIAN � � CUMPANY � <br /> SIC+NATUi2E REGISTERED Y I IU� FEE CURRE� Y I N <br /> � A�idress _ 1 t�lcense# � � �� <br /> �.� <br /> �I PLUf4!l3ER COMFANY .,,� <br /> � SIGNATl3ftE � � R�GI&TEREQ Y I N FEE QURREti Y/N <br /> l�ddrerss !lcerase# � �� <br /> MECHi�NlCAL COMPANY ,� <br /> S�C�NATURE � t�GtSTE�tEp Y t N FEE CURREi� � Y 1 N <br /> ' �\�idress C Lfoen&e# � � <br /> OYH�Ft COMPANY <br /> $ICid`ti4TU12E REf3tSSEREp Y i N F�CURRER Y I Id <br /> Address LiCense# �_ , � <br /> -Htt�lt4ti•1#t�tiitH � <br /> RESIpIENtfAI. Attach(2)Piot Plans;(2)seis of Suilding Plans;(1)se!of Energy Forms;R-O-W Perm(t for new construct�on, <br /> NIlnEmum!en(10)working days�fter submtitai dafe. Requlred onslte,Consfructlan Pians,SMrmwater Plans w/SHf Fence lnstalled, <br /> Sanitary Factfittes&1 dumpster,SEfe Wark F'ermit for subdlv{sfans/Iarga proJects <br /> COMMEFtCIAL Attach(3)complete sets of Buliding P►ans plus a Lifs Safety Page;{1)set of Energy Forms.R-O-W Penmit for new construcilon. <br /> Mintmum tert{10)warking days�fiter submSttat date. Requlred ansite,Construction Plans,Starmwater Plans.wl8tit Fe�ce lnstalled, <br /> _._____ - __ •�_ -ganitsry-E=a�itif�es-&1-clumpsi+ar.-Sif�-Wo�kPern}It for aii�r�ew prajecis:fiii com`merciat"rec�uifemenis must ineet comp iance M� � - � <br /> 51CiN FERMIT Attach(2}sets ot Engineered Plt�ns. <br /> - "`"•pROPERTY BURV�Y required€or af!NEW constructfor�. <br /> zcurxs <br /> olrecrlons; <br /> Ft(1 aut aRRifcatfon campletaly, <br /> Chmer 8 Contrecior slgn bank of application,nUtarized <br /> IP�ver S��QO,a Notice of Cammancement is requtred, {A/C upgrades over S75AQ) <br /> " Ac;ent{for the ccsntractor}�r Pnwer of Attomey(for Ehe nwner)wauid be someone with nota�ized letter fram awner suthari2ing sama <br /> OVER.THE Gt)UNYER PERMfiTING (Front of Applfcatlon pnly) <br /> Reraof�ti shingfes Sawers Servlce Upgrades AtG F8t1G98{PIoUSGrif6ylFOqf�gB} <br /> Driveway�a-Not over Caunter if an publiC roadways..noeds ROW <br /> t -- - <br />