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<br /> F ' , � Bu}tding Department
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<br /> Date Rseslvud -'7r�� phone Cantaaf iar Permittin u 1 3 2��"P-� �lc
<br /> �2�3� .CL�Y2X�
<br /> Qwrre�'s Nan�e � �Q s�l ni 2� Owner Phone Numt�er �b �- 3�'�`�� �
<br /> Ownsr's Adclress 5��� � Owner Phone Number � �]
<br /> Fee 3lmple 1'Itleholder Name �, � flwner Phone Numher � ��
<br /> Fee�imple 1'itleho�der Address �� , ��
<br />( JOB ADDRESS ��7�/C� � CFi 5�r/�,�z�� f.��2 ZePh R y�,,��/S FL 3�Sy� l.O7# �F?__�
<br /> SUBfi3tViSION C�,I20/�av Ic��/-�njc7F: I PARCE�.tD# ��T„-ZG _`Z.1-- G7 t 20^ G Laca�317 ���,6G_,,,_�
<br /> (OBTAINED Ft2QM PftOPERTY TAX NOTICE)
<br /> WQRk PROF't}SEi� NEW CUNs7R ADDIAl.T � SfiGN [� �� DEtNd�tSH
<br /> e INSTAI.L � ftEPAiR
<br /> �aoE�as�c�us� � sF� � cor�n� � oT��� C� �_�
<br /> TYPE OF CONSTFiIJCTtON �] BLOCk; � FRAME � STEEL [,,,�] � ��]
<br /> DE8C�2iP1idN OF'fNORK �1tiiC2 j� r.�!e��V��E�I'S +�t3 � ,Q��c'N��.1�S ''r"'`.�i�l$,'�.� �4.!�"8J'� �. 3. �.,
<br /> I `�"" 1 �vc� a "�-��'�/'•s'%z.�: ,G'�. 2�y6, �
<br /> i BUILt�tHGStZE � � �QFOOTAGE��,z��� NEtGHT � �
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<br /> ��BUI�[?iNC3 � � . VALUATIf?N Or T{)TAL Ct}NSTRUCTt{}N
<br /> ��1�. G7+o�
<br />, [,�EII�CTRICAL � � An�l=s��vic� 0 f'RtJGF2ESS ENERGY Q w.�.�:.c.
<br /> C�p�u�,a�N� L.� ___J r
<br /> [��MECHAMCAL $ VAI,UATlON Ur MEGHANICAZ lNS7ALLAT}4N r��� ( ��
<br /> [_�GAS Q ROOFlNG [� SPECIALTY � OTNER
<br /> FINISHED FLOOR�LEVATIONS � � FL�00 ZONE AREA DY�S NO
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<br /> ttttfiii ti-t#tfi ti'F#'ttt't'ti'�tfitfittt't't'ti"H i-Ettt#t-3iti'{'t i
<br /> BUtL�?ER .� CC}MPANY t.-OLttE'.5 4"'�t's!�'1 T'f�.(�, l-.�(..' �
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<br /> SiGNATURE ��T�",� Ae.Tlf+oN'/ Gt�ARc� R�GISTEREb � Y/ N- �EE CURRE� '�' Y/N
<br /> ,��aress {�o E3ox ?St��i3 ��z.1Anr��, �-c,�78 �tcense# G�GtsogYf7 ��
<br /> ELEG1'RtCiAN � � CONlPAHY ,�
<br /> $IGNATU�� R�GtSTEREd Y I fV FE£CURREh Y/,�
<br /> t��dress � � Llcense# �.,._ ��
<br /> PLUMI3ER � CpMPANY _^� I
<br /> SIGNATUitE ��cisT�a Y 1 ht � FEE CURREh -[ Y 1 N
<br /> A�fdress � ____� Llcense# � �
<br /> MECt1�4NlCAI_ CCfMPANY
<br /> SSGNATURE � rz���sT��E� Y t„N���EE cu���E �Y!��
<br /> I\ddress C � Liaense# �� �
<br /> I OTH�Ft COMPANY �]
<br /> slGN,4TttRE � REGI5TERED Y 1 N PEE CURREA Y!N
<br /> ' llddress � Ltcense# � 1
<br /> -tfi-�t+ltifttH�i'�ti-tttl �
<br /> RESI[)IENTtAL Attach(2)Piot Plans;(2)sets pf Bulidfng Plans;(1)set Of Energy Forms;R-Q-W Permit for new construction,
<br /> Iulinlmum ten(10)working days after submtttal dats. Raqulred pnsite,Gonstructlon PSans,5tormwater Plans w/S!!t Fence lnstalled,
<br /> Sanitary Fac111ties&1 dumpster;S1te Wprk Petmif for subdivtsionsf�arge proJects
<br /> COMMERCIAL Attach(3)complete sets of Building Plans plus 2 Life Safety Page;(1)set of Energy Forms.R•0-W PeRnit for new canstructlon,
<br /> - Mlnlmum ten(14)worktng days after submftta!date. Required anslte,Canstructlan Plans,Siormwater Pians w!Sitt Fence installed,
<br /> Santfary.�ac(tittes&1 dumpster.Sife Wotk Pern3i,foc aii_na;v pt'oJects._Ail commarclai requlraments rnust meet comptiance � -"' `- -
<br /> SIC3N F'ERMIl' Aftach(2)sets of Engineered Ftsi�s.
<br /> ' """PROPERTY SURVEY requlred 1ar ai!NEVY consiructforz.
<br /> 3�TIT g
<br /> Difeckhmst
<br /> €'�I(out appi�cat(an compietefy.
<br /> Chmer&Contractor sfgn bsok af appiicatton,natarized
<br /> 14��ver S:!500,a Notice of Commencement Is requlred. (A/C upgrades over 575Q0j
<br /> " Ac�ent{tor the ccmtractar)�r Power of Attomey(for the owner}wau}cf ba someone w3th notarized�etter fror�-i owner sllthosiz�ng same
<br /> OVER 7HE Ct)UNTER P�RMii'TING (Front of Applicatlon pnly) -
<br /> Raraofs If shtngtes Sawers Service Upgrs�des A!C Fences(PlflUSurvey/Footage)
<br /> Llriveways-Not over Counter if nn pubtic roadways..noeds RC1W
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