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u�s-iau-uuzu C:ity ot zepnyrnu�s Nermit App�ication rax-s�s-iuu-uu�i
<br /> • Building Department _
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<br /> Date Received ,
<br /> - �.Phone Contact�.for Permitting — �
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<br /> Owner's Pfame Owner Phone Number . ,
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<br />� Owner's Address Owrner Phone Number
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<br /> Fee Simple;Titleholder Name � - OwnerPhone Number
<br /> � �'�,�v �dTk� ��-- �
<br /> Fee Simple Titleholder Address ..� '
<br /> � S., �SU ��,� ST ;
<br /> JOB ADDRESS LOT# � I
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<br /> SUBDIVISIOM PARCEL ID# .-
<br /> ; , (OBTAINED FROM PROPERTYSAX NOTICE) �
<br /> ViIORK PROPOSED , NEW CONSTR' - ADD7ALT 0 SIGN Q � Q' DEMOCISH � !
<br /> B INSTALL e REPAIR
<br /> PROPOSED USE Q SFR Q CON1M � OTHER ` �
<br /> TYPE':OF CONSTRUCTIOfV Q� BLOCK - Q FRAME Q STEEL Q
<br /> DESCRIPTION OF WORK '~ �. �V�' � �✓/�'�rf �WT`��1�Uw %✓v �V�✓W` i ��� �JnS
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<br /> BUILDIPIGt$IZE � SQ`FOOTAGE�� �HEIGHT • __ , '
<br /> OBUILDING $ VALUATION'OF TOTAL CONSTRUCT.ION
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<br /> �LECTRICAL $ �� /�--� AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
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<br /> I QPLUMBING $
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<br /> QMECHANICAL $ VALUATION OF MECHANICAL.INSTALLATION ����/� /� 3��
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<br /> QGAS Q ROOFING Q_ SPECIALTY Q OTHER
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO ,
<br /> BUILDER ; COMPANY �
<br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address License# �
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<br /> EI:ECTftICI� ; � COMPANY I��r' C-�"� �����'1 � , �
<br /> -SIGNATURE �`���� �����'f REGISTERED Y/ N FEE GURRE� ' Y/N. ;
<br /> aad�ess ����`� ����'V'�. �"T�� - ��cense# � O t1 l ZZ 2�°
<br /> � PLUMBER'. . 'COAHPANY �
<br /> SIGR�i4TURE REGISTERED Y.-/"N ` ` .FEE CURRE� Y/N
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<br /> Address - Licen'se#; �
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<br /> �°.' MECHANICAL� '� � � ..COMPANY i
<br /> i �'"`SIGNATURE'`-''� -' �� � REGISTERED ,' Y/ N EEE CURRE� Y/N �
<br />, A�ilressir`-� . ' : , License.#
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<br /> OTHER:�.:�::.: - . , . , 'COMPdWY _ ,
<br /> ;�':'$IGN14TURE',;*:r:: ;.r ,� ' ' REGISTERED ' Y/.N FEE CURREK , Y/N i
<br /> _ Address�;� . �..r,,:• _ �;z;:�r.�.I;., . - :� - . License# I
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<br /> �'��RESIDENTI"AL't�_=A 'ch';>2. FI,.yPlans� � -o�B�ildin aPlans�`1=�s 't'of Ener'� 'Fo' s•R=O=W.Pe �it orrnew,construction.
<br /> , . , . ,,.�„ _,(...)�.�ox,... .�l2.)"sefs u g �( ) .e sY. .� �. ;.�.,- R" �. ;:��. . �
<br /> . �. 4 - . - , _.�- - _ ,:.
<br /> , -:.,_..�;x-::Minimum;tenu(�1Q),working�day�_;aft"_e"rsutimittal:'date.:3Required��onsife;'Con'struction Plan"s,�Stormwater Pl�r1s w/Silt Fence installed,
<br /> ;,: • . ..�wa:._:.;��,, � . t� . . .
<br /> ;��,=r ; , �4 Sanita,ry�lFacili6esr&1+dumpster;,SiteVllorkPecmitfo�si�tidivisions7large'proj�cts ;,: ' :`� ' � �
<br /> :,;s;COfiiIMERCIAL Attach`�(2)=compleCe's'efs of'BuiliJing Pi`an"s plus a 4ife Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction.
<br />---t�=�'.� �=� _ � -- "Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence.installed,
<br /> -_;,,',' Sanitary Facilities 8�1 dumpster._Site Wo�lc_Permit,fo��all,new projects.All commercial requirements.must meet compliance '
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<br /> - ,.��..�_ ..:�....t�. _.. ; ._
<br /> ��'SIGN':PERMIT �Attacfi°(2)setsagf:Engineered;Plans:��:<�� :��� _ • • � � �
<br /> a�,fi_; ,
<br /> ;�>?�>� "'"PROFERTY SURVEY.regutred.,for,all,NEW�construction._ .
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<br /> �:�Qi�ections: ¢-'•?R°�:«"c.i3..�. - '
<br /> _- � Ftlf outapplication completely.~s - �
<br /> _ Owner.8�Contraotor sign:6ack ofapplication,notarized �
<br /> _ If.ovee$2500;.a Notice.of:Commencement ts Pequieed. (A/C upgrades over$7500) _ , �
<br /> ��� ,.->_..,:.„;,,,�..,
<br /> ':";- Agenf(for'the�cont'ractor)=or°Power of Aftomey'(for tFie'owner)would`6e"someone with notarized letter from owner authorizing same
<br /> ;�.OVER:THE�COUNTER P,�RMITTINCa`, (copy_of contract:required) - - - �
<br /> �;'Re�o'ofs'-if sfiingles �� Sewers Service Upgrades A/C Fences(PIot/Survey/Footage) �
<br /> � :...�,-.:� „- .. .
<br /> "Dri"veways-Not over Counter if on publicroadways:`:needs'ROW
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