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<br /> s7�3-7sa-�oza City of�ephyrhilEs Perrnit Applic�tion _ _FaX ss��-7�-aoa,
<br /> • Building Department �
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<br /> Date Receivec9 � 3 � � _ ? a �
<br /> . �.Phone Cbntact for-Permitting � �
<br /> Owner's Plame �C�"�� < <''�"' Owner Phone Numb�r �
<br /> Owner's Address . ' Owrner Phone Number � �
<br /> Fee Simple�Titlehotder Mame ��� � Owner`Phone Number� �- �
<br /> Fae Simple��'itleholder Addr.ess -
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<br /> JOB ADDRESS ' � � C�� �''1- �_ �=�...... � '`n� 3 `'�-�� �
<br /> su�atuisio� � � p,a,�c��:i� �
<br /> ! (OBTAINED FROM PROPERTY TA7(NOTICE)
<br /> WOR4S PROP08�D e ., IVEY+1 CONSTR 8- ADD/AI.T � 3fGR1 � Q DSMOLISH
<br /> INSTALL '•REPAfR
<br /> PRO!?OSED,.USE. Q_ SFR Q 'COMM C� OTHER �
<br /> 7YPE':�F CONSTRUCTION [� BLOCK - Q `FRAME � STEEC [�.
<br /> � �. i� � -
<br /> DESGRiFTi�QN OF WORK `l �^~`�� �' t�"-� O�� �� ���
<br /> BUILCIItdG 5l2E � � SQ FOOTAGE C„� N51GliT ��_
<br /> OBUIl.DING �& � VALLtAT10N`OF TO'fAL CONSTRIJCT.ION -
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<br /> E�ECTRIGAL �� AMP SERVICE Q PRQGRESS Et+lERGY Q W.R.E.C.
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<br /> Pt�UMB{NG $
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<br /> QMEGHAN1CfCL $ � -� VALUATION OF MEGHANICAL INSTALLATION
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<br /> Q,GAS Q; ROQFlfVG [�J. SPEClAI.TY � OTMER •
<br /> FINISHED FLOOR ELEVATIONS �� FLOOD 20NE AREA QYES NO
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<br /> Btlit,DE�d : CO�ftPA1dY
<br /> SIGWA►TUR� REGISTERED Y'Y N _' FeE CUR�n Y�/N - - - � ,-"�
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<br /> i . �Address �l.icense,# � �
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<br /> ",;ElEC�TF2i,Gii4Al. ;:., GO�iiPANY •
<br /> �r..`SIGN�TURE REGISTEREp Y/ N• �FEE°CURRE� . " Y/N.
<br /> . Addrass ` - Ltcense# � '� �
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<br /> �:��un�s��.;� � co���Y�, � L.��,�'� ,�?. -
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<br /> ,ri� SIGN�7'UF3E ' ""`��� REGISTERED Y I 'N � " .FEE CURRE� Y/
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<br /> Address t1�1 �l��,�'"�� }$-^'"`.-s' l.lcen"se#,C L.,�` �.. I '{ �� ��
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<br /> `_'-MEGIiA1VIGJ�l: f - �OMPANY , .
<br /> �'`SIGNi�TURE''-� `'�� ' � ' " ' REGI3TERED „ Y/"N FEE CURREh Y/N ,� ,
<br /> �ddr`e����� _ , , license.# { . . � -
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<br /> •;.OTHE��:...'°,:-, :. _ � . � � - � `�t�MPANY -
<br /> "�"�`SIGNI�TURE f��r:_:;� ' _ " " '' 'REGISTERED Y/N. FEE CURREK Y/N , ,
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<br /> �zy: C'�tr s '�� .r . «
<br /> �,: Addres�,_:.,_ - � �a¢.� - . �L:icense#
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<br /> $��;RESIDENTt�t:�;�� ��Atfach;;2;;PIot:Plan's=�:2�:�efs°of 8uildiri ��?larisi�1i�:sef'of�Enetgy,Farrtis��R:O:W Perrrilt�foc newr.constniction,�
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<br /> ' � .-:;';-,.�;::L.�.w.NliNmu �he °�1.q,;workin''f�da�:s�afte�:"s;utiimiitala:date.`=Requi�ed�onsite;TCoristiu`ckion`Plans;Sto"rimwater Planswr/Siit Fence instailed,
<br /> �`a= "4'..�. :i�.; ..� t�(,....)a .�9d Y.. , . . , . . . . , .
<br /> _ ��" ���Sanitary;l=�acitities3&rss1�dumpstec;.Sitet�,W,ork�Rermit.fo�;si�tidivisions/la`rge':proJects.'.�- .. ._ _ -
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<br /> `�•.':GOfl?f1V0ERC1A1. Attact►�(2)�cotnplete sets of`Builiiirig=Plans ptiis a tife�Safet}i Page;{1}set of Energy Forms.R•t�-W Permit for`new cons#ract�on.
<br /> "� � Minimum ten(10)working days after submittal date. Required ansite,Construction Plans,Stormwater Plans w/SiR Fence.installed,
<br /> _``"°' Sanitary FacaHties&1-dumpsterN Site Wc,�c Permit foi-�it�new.p'r.ojects.All commercial requirements must meet compliance
<br /> '`�::Si,GNr:P�Ri1flIT "fitfacfi j��j"sets;af;Eiigi►ieererlxl?lans;:�= _ .Y.-. , , � -
<br /> ��n""'`� ' """*PROPER'fY S�IRVEY_requiredMfor,all,NEW constructlon:. ,
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<br /> ::Di�e�tfqns: :�.: ;�M,.,,x„�. -, ,
<br /> ' ''�Fill<out=application completely.
<br /> :�= Osnmer`�Cantractocstgn.back a#appllcation,notar+zed
<br /> _��' �I�.aver:$2500;.a Notic�-of:Corromencemenf(s required. (AlC upgrades over$7900) _
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<br /> Agen#�{for ttie�carit�actor)t.or.Power ofi��ttomey(for'the owner)would`tie"sonieane with notarized letter fram owner authorizing same
<br /> 'w,:: ,, .�.� ..
<br /> =`�;OVER;;YHE'GOUNTER,�PERMITTIWG,� , .(coPy.•af.:contract:required) ` ' ` ' �
<br /> �`�Rerpofs:if stiingles Sewers Service Upgrades A/C Fences(PIot/Survey/Faotage)
<br /> ��: � . .
<br /> . [Dr7vewr�ys-Not over Counier ifon�public roadways::ne'eds'RQV1/ _
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