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ts�s-�Su-uuzu c;ity ot Gephyrhi��s Nermit App�ication rax-��s-iesu-uu��
<br /> , • Buifding Department
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<br /> Date Rece�ved '�j � - �./ � _
<br /> �.PhoneContact�.for.Permitting �a� � — l��
<br /> Owner'�Name .er(}�, , v..+1. L�� Owner Phone Number O(3 �J�a ��� ,
<br /> Owner's Address �ia �v fiQ,Yh Q - 7 U� Owrner Phone Number �
<br /> Fee Simple;Titleholder Name '� Owner�Phone Number
<br /> Fee Simple'Yitleholder Address �
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<br /> JOB ADDRESS 3�7 � �- � i� � � �� � 3����� �oT# 1�
<br /> SUBDIVISION ���IS � iv� PARCEL ID# I� �D � �(�.C7� C��`C�J C7 V
<br /> � _ (OBTAINED FROR9 PROPERTYSAX NOTICE) -
<br /> VYOFiK PitOPOSED .. NEW CONS7R' ADD%ALT � SIGN Q � Q' DEMOCISH
<br /> " e INSTALL 8 'REPAIR
<br /> PROPOSED;.USE Q SFR Q COIVIM Q OTHER
<br /> TYPE'.OF C�OW$TRUCTION Q� BLOCK - Q. 'FRAME Q STEEL Q.
<br /> �
<br /> � � 1 I � `�^ 1� �� �
<br /> DESCRIPTION OF WORK ^ ��a r OF-F •f I.QC�- ��fi�S ITl l� ��T c���Wl �'�
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<br /> BUILDIPIG:$IZE SQ FOOTAGE _ �� HEIGHT •
<br /> 7:4 • I
<br /> BUILDING $ ��� VALUATION'OF TOTAL CONSTRUCT.ION I
<br /> �.b
<br /> �ELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
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<br /> QFLUfVIBING $ (� _
<br /> f V ��
<br /> QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION � �`Q
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<br /> ,. ,
<br /> Q,GAS �] , ROOFING � SPECIAITY 0 OTHER
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
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<br /> BUILDEI2 , COINPANY l i'► �Y1
<br /> SIGNATURE REGISTERED Y N URRE� /N
<br /> � �lddress License#
<br /> y ,
<br /> � _
<br /> �'ELECTRICIAP! ;. CONIPANY
<br />, '-�`SIGNATURE REGISTERED Y/ N FEE CURRE� ' Y/N
<br /> �►ddress ` License# � �s
<br /> •- P �
<br /> LUflABER.i. , . COMPANY
<br /> �IGNi4TURE REGISTERED Y/ fV FEE CURRE� Y/�N
<br /> Address, License#' ��
<br /> ;;`iNECHi4NfC�L� � GOMPANY
<br /> "` SIGNATURE•'° ' �� •'- � REGISTERED , Y/ N FEE cuw;en . . Y/N
<br /> �►dd'ress�r� ` • � • ' License.#
<br /> :� .. .. . , -
<br /> ;`OTHER;..:<;.; �,: � ` `COAAPANY �
<br /> :"'SIGNATUREi:;.:�� ;� - - ` "REGISTERED ' . Y/.N FEE CURREK Y/N
<br /> , ,-z�::;���:H= ._, ,- . , .
<br /> �ddress;� �_.�-�..�5�,�-.�1=,�.,�,,�, c�- v.e: o -s�G� �� -- . �Cicense'# CCC 33/0
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<br /> - _ , , } _ .��;���a - - _.. ,
<br /> rRESIDEWTIAI:h:� ';Attacfi';2,�PIot�Plans. Z�sefs%ofi"Builciin�rFlBn`s� 9���set of�Ener' `Forms R=O-VN Pe� it fornew.construction
<br /> �.,�s.,_,_„_ ... ,_�,.)... _:�� ) 9 �� ) . 9Y. _ � ��,:
<br /> :::: .. •,A..
<br /> ,_ ;.;,.,-v.�:,�::.Minimumtiten��1U.wo�kin"�da`:S`.tafter`s.ubmittal:date:�Re uired onsite�"Gonstru'ction�Plans,TStoianwater'Pl��s w/Silt Fence installed,
<br /> :?diT . ,_,..�..��. R . :.9,. .Y.. q
<br /> .' ,.� .^b:. r'a �.'.'+�;' _ � . .
<br /> 41{fy� '7; . .._ , _
<br /> ��4=J„ ` Sanitary?;Facilitiesq&�1,;dumpster;=Sife;Wo,r,k;,Pe,rmit.forusqbdivtsions/large�'pr`ojects:,- , , � ,
<br /> ;C.OMMERCIAL Attach�t2)�zcomplete sets of'Building Plans`plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction.
<br /> - - - - .: Minimum,ten(10)working days after su6mittal date. Required onsite;Construction Plans,Stormwater Plans w/Silt Fence installed,
<br /> -- _ Sanitary Facilities 8�1 dumpster.Site,Work Permit fo��all�nevii.projects.All commercial requirements must meet compliance
<br /> a=;�:SIGNt�PERNIIT �Attach`°(�)'sets:of:Enginee�ed Plans:�t= � :�4 , . , - �
<br /> __- _ ""PROPERTY S�IRVEY reguired fo[�aII.NEW construstion:. I
<br /> ,.'.� ._.._ _
<br /> =:Di�e;cyons: � , ,.. ,;:r � � ,
<br /> `� �Fil4.out`application.completely.x+.
<br /> �" O�yner;&ContraCtorrsign�back.of�application,notarized
<br /> �`� If over'$2500;a Notice.of:C.omrerencement is required. (�41C upgrades over$7500)
<br /> J�: .
<br /> i:'".:� .Ag8�1t'(fOr'tlie=cont�acfor')=orPower'of'Attomey(for'the'owne�)"would tie someone with notarized letter from owner authorizing same
<br /> =r"OVERiTHE COUNTER,wP�RMIT�ING:. ..,.,(.copy;ofecontract.reqwired) '''```
<br /> �:'Re�oof§..ifsti�'ingles y Sewers Service Upgrades A/C Fence's(Flot/Survey/Footage)
<br /> Driveways-IVot ove�`�Counte�,if;on pulilic roadways.°:rteed`s`ROW �
<br /> '.'... � i.:-.�v�::',.J � ,..j._r_ , . ,. ;
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