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<br /> azs-��o-002o Gity of Z�phyrhi!!s Permit Applicatlon FBac-813-?80-QQ21
<br /> � Building Departrnent - � h'
<br /> _.«rate Reaelved !� � . Rhone Ca�ol�ct for Permtttin — '
<br /> Owner's Name /���J`�i f _ /� �C'�Jh�'�h✓l' .��C�'4�' Owrner Phone Numbsar � � "��� '�� ��
<br /> qwner's Ad,dress ���..,� t..� ��/� ��� G� • Ow��P�on`tTumber
<br /> F�e Simple TttReholder Mame ��/�� /'���� ��/V�+r1�� Owner Phone Numbe� 1 ' �
<br /> � p. / � �
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<br /> Fee Stmple;Titieholder/4ddrs�s �! �G� J"��L'r'�f ��� -G-�"pi�'� t�/'fJ�S �L. �.� 'J'�� `
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<br /> �os Auor�ss � /�1� �e��'/'�' ,�c'�i�f/C.�„i .�L � �.oT# ,
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<br /> � i .��'�������r �� � �2 ��� `" �S�'��a'" t�oD
<br /> susoivisidN �%��,���z.,�'�.,��_ �Paac��.oa� ���-- �- .
<br /> � - �Gp�� tt�/./t , , , (OBTAINEDF.ROMPROPERTYTAXNO t�CE_)
<br /> WORK PRO,POSEd EW CONSTR .. '- ` ADD/A1.T �� S1G(V [� � Q DEMOLiSH
<br /> _ ' e; lNSTAt,:L REPAIR �
<br /> � �PROPOSED-U$E Q SFR 'CQMM ' � OTFlER '
<br /> TYPE OF CtJUNSTR!lGTION Q ''' BLC)GK " Q FRANIE ��,] STEEC �
<br /> DESCRIPTION OF WORK ' y �/�.�� �j� �G�I�/C����!/Z.+l�.u��,I� M�L-' �1.�1�.1��.[��
<br /> Bt71LDtNG 812E 'l � �3{ �!� � ��SQ��OOTAGE "�I�� . : . ..HE1CaHT��,/��� .,
<br /> �s���"����`' $ �.l"'� v�� VALUATIONYOF T07AL CONSTRIJCTION�• ' -
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<br /> �EL.EGTRICA4. . $ � �Q��-, AMPSERVICE �'pp��yt�� PROGRESSENER�Y [� W:R.E.C.
<br /> � - � .. __ �c,�k� ���-�'�y/ � {��
<br /> QPL'UMBING $ � �
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<br /> �]MECHANICAL ` $ � ��� VALUATlON OF;MECFiANICAI.INSTALfRTlON, �'�/L�
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<br /> QGAS Q f�00FING Q SPECIALTY;� �OTNEEt - '?j � t'�� .�j
<br /> FINISHED FLOOR ELEVATlONS ��,- FLOQD ZONE AREA ;��'QYES NO (� P
<br /> Sti�t�W' p'- �-�"i"t .t�� �J-� �.�, � �U►�'`
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<br /> �IGN�►TURE � � ttEG�St�D Y! N � F�GURR�t+ Y 1 N
<br /> Address {1 p � � Ltcense# ��(�d �� �1r 1 �,7' �
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<br /> ELE��i�l1C.lbN _ t� �/y )� ��,,"' �'} ��:COMPANY ` �2�e ���e cr�/�V'Z'"� sl
<br /> SIGNATURE J 1V�"'��` �"6 ttE��sre�a Y! N F�ctir���- '" '�Y!N '
<br /> c� ces`s - - _ � � , . � � , , , License# � �=G' t S 00'(3 S 3 �
<br /> P���� � �C{?MPANY � �y�d F"l� fc� CI�e��nc pf3�
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<br /> SIGNATURE' _ . , ��t��isreREa Y,l.N< = - �e cu�c�n • YJ N, �:°
<br /> Address r� � ����. - , " Lii�nse# .��a 2 j�..t�,- - � _
<br /> MECNANlGAf_ • � � .. � _ ' CCiMP11NY � '"
<br /> 51GNATURE � � ' ' � ` KEGISTERED .� Y./_N �sE�curu�n-� Y.l�N �
<br /> Addreas`- , � _ �:' , x-` . . -, ' License# � - I
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<br /> 07HER ' . � � � ��COMPANY.. ,
<br /> SIGNATlBRE ,. - `:= . . " ` `' 'REGISTEttED"-. Y! N-.:, �e cU�r' Y!N
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<br /> I4diU8$$ - , 'S`_. - . ,. . [.iCenSB# � ' ._�; .
<br /> � 7 -. '. " �,-_. . .Y.,.� .,.,r-• d>:• ...`�:i.,;.. ,:� t} ��t.r�•a':i... . . ,;.� ..,. .. � .? .4 . �
<br /> RESlDEPITIAL,',�AttacH"{2)FPIof�.P,laris;.,(2jsets:of+Bullill`ng.Flans;{1j_sef_af-'Energy�Fortns;R�W�PerrriltforrsswconsbucBan, '
<br /> ,; MlnimumSten°(1.0);working,days';after submittaliiate�:Required cn`sife;.Co`nsiiucdon�Plans;'Stoimwaite�"'Plans w!Sllt'Fence installed,
<br /> ` .:'�.: Sani'tsry�Facllitle.s;&;,1�cdumpster,,Site-Work;Perrnit far.su6divisions/large p„nbjects�?, �,:i;;.>� . �. ,�" � " ' `' `;
<br /> COlVIM�RCI�1L Attach 3�com�!et`e`�seis cf�BiilEilfii�"Piaris liis a�Life Safe 'Fa e, 1 set af Eae Fatms,R-t?-W Perm�t for reeW cor�struction.
<br /> O� P 9 A tY 9 't } t9Y
<br /> Minimum ten(10)warking days after submlttal date. Requtred onsike,Canstnrcdon Plans,Stortnwater Plans w/SUt Fence lnstalled,
<br /> Sanitary FadiiUes&1 dumpster.Site Work Permit far all new+projecfs..Ail commerclal requlremen�.must meet compliance �
<br /> SlGN PERMlT Attacti{2)`setis of Eaginee_red;Pians.;:- ��-- ' � ". ' ' - . r .
<br /> -�� ""•PROPERTY SURVEY required for_aU„NE",rV gonstc,uction., �
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<br /> Dlreciions: , _. � � � . �
<br /> Ftll out appllcatlon campletely.
<br /> Owner&Contractor sign back af applicadon,notarized �
<br /> If over�2500,a Natice af Cammencement ls required. (A/C apgrades over�TSOOj
<br /> 4.�,�„,__, ,., ,
<br /> � " Agent(fot the contractdr}or'Pawe�of Atfbmey(for the ownsr)wautd be someone wifh notarized tettet from owner suthotiz{ng same
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<br /> ' OVER THE COUNTER.PERMITTiHG.. _ ...(Front of-ApPlication-0n{y)_ - _ -
<br /> Reroots 1f shingtes Sewers Service Upgrades A!C Fences(PlotlSurveylFootage}
<br /> drivewaya-Not over Counter if on pubtic roadways:.needs ROW
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