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� r..a� v�.�.��revy'n4w��mra��f�pyG.�I,Li,i _.._.'"'"'- <br />, • Bullding Oepariment � <br /> -n!f LA <br /> DuleRecelvod �/ �6'�{ �� bs <br /> P,hon Contset for Portnit in <br /> Owner's Name r Pho e Number 7 _Si -q 7'7 p � <br /> �J(� ;�IA / C��LL�- <br />, O w n a r s A d d r e s s 1'i �d O wner P hone Number 1 <br /> Fee Simple Tltlehoider Name � � Ov,mer Phon�Numhor � <br /> Fee 3lmple l'itleholder Addreas �`— <br /> JOB ADDRESS 3/ 2��p �J!J�,a g�.G fj A p �{pl LOT p � <br /> sueorvision 'Z- �-�� (15 Cr,l���_ PARCELIDC bI `��-�I'tJ�((�-- �jQQp '�G(��� <br /> �OBiAINED Fn�OM PROPERTY T�ncE)DEMOIISH <br /> WORK PROPOSED NEW CUNsiR ADD/ALT � SIGN <br /> INSTAI_L e REPAIR <br /> PROPDSEO USE Q SFR � COMM Q OTHER �-- <br /> TYPE?OF CONSTRUCTION Q BLOCIS Q FRAME � STEEL Q � � <br /> DESL`RIPTIONOFWORK �/�ISI � /��nlLL � S�� /�'TAc�ey" � O �� (,(��4,L (fik L <br /> BUILOINGSIZE 30fOOTAGEC� HBIQHT � �V 2 L7' ?C� /W�r�Vr�/ L, <br /> �uzcrs j <br /> � ��"'��e. <br /> BUILDING $ _�r �y2,� VALUATION 01'TOTAL CONSTRUCTION O <br /> � <br /> QELECTRICAL �$'� AMP SERVICE Q PROGRESS ENEROY � <br /> �— Q W.R,E.C. <br /> �PLUMBIN6 $ <br /> ��dECHANICAL �� VALUATION OP MECHANICAL INSTALI./\T10N ]�,')� <br /> ��� v✓ <br /> [�GAS Q ROOFING � SPECIALTY Q OTHER � <br /> FINISHE6 FLOOR ELEVA710NS � FLODO ZONE AREA QYES NO <br /> i+hftM+llitttttttfitMt t}}{}�ry�ry 1 <br /> BUILDER vl/+'1 • � ANY O WLS•. I^fOA'1 T2Jt �� <br /> SIGNATllRE QiQ q�T]'j�pPl�/ RO REGISTEREo - '"'Y/ N FEECURAEA Y/N <br /> Address Po (3o x ?S 19 4 3 a Rl�rdc, �i '3 zS78 Llcense# G4��lsogyl 7 � <br /> ELECTRICIAfY I COMPANY �] <br /> SIGNATURE REGISTERED Y/N FEECURRE� �YlN <br /> Address License#� <br /> PLUMl�ER � COMPANY ] <br /> SIGNATURE REGISTERED Y/N FEE CURttEn Y/N <br /> /��]dress � <br /> Llcense p �_ 1 <br /> MECHANICAL � COMPANY 1 <br /> SIGNATURE REGISTERED Y/N FEE CURREM1 Y/N <br /> Addrase LlcenSB p <br /> OTHEit � COMPANY � <br /> 910NA7URE REGISTERen Y 1 N FEe CURREn Y I N <br /> llddress Llcense# � <br /> iii#'f+Itti�F+f 41i-FF1 <br /> RESID�NTIAI. AHach(2)Plol Plans;(2)sels o!Bullding Plans;(t)se!ol Energy Forms:R-O-W Permlt for new consWcGon, <br /> Mlnlmum len(10)workln0 days afler submlt[ai dete, (iequlred onsi(e,ConstrucUon Plans,Slormwaiar Plans w!Slll Fenca Installed, <br /> Sanilary Fa�lllles&1 dumpslor,Slle Work Permit►or subdlvlslonsAarge projects <br /> COMMERCIAL Attaeh(3)wmptets sets of Bullding Pians plus a Life Safety Page;(1)set o1 Energy Forms.R-O-W Pertnit for new construcllon, <br /> Mlnimum ton(10)workfng days aRor submiftal Oala. Requlred onslle,ConstrucUon Plans,Stormwater Plans w/Sllt Fenca inslalled, <br /> Sanitary Fadlllles 81 dumpsler,Site Work P-ettnll!or all new proJects,All commerclal requlremeMs must meel comptlance <br /> SIGN PERMIT Attach(2)seta of Enginsered Pl�ms. 1- <br /> ""PROPERTY SURVEY requlred for all NEW canstrucUon. <br /> Olrectlons: � <br /> FIII out appllCalbn camplelely. <br /> Chmer&Contreclor slgn back af applicallon,nuladzed <br /> IP aver 52300,e Notice o}Commeneomont is roqulred, {q/C upgrades over S7b00) <br /> " Agenl(for the contrector)or Power o(Atlomay(for the owner)would be snmeone wllh notarized letler from ovmer euthorizing same <br /> OVER THE CUl1NTER PERMITTING (Front of ApplicaUon Only) <br /> Reioofs.11sh(ngles Sawers Servlce Upgrades AIC Fences(PIoVSurvey/Footage) . _� <br /> ariveways-Not over Counler It on pubtic roadxreys..noeds ROW <br />