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tiunaing uepanment rrll L <br /> Date Received` ( ( j Phone Contact for Permitting <br /> Owner's Name l�➢ �'V `� aso n Owner Phone Number �`3 D-D �:�8 a <br /> Owner's Address r �. 1 v�c�sl �I� m+�� N\ Owner Phone Number <br /> .Fee Simple Titleholder Name Owner Phone Number <br /> Fee Simple Titleholder Address p (,� ` <br /> JOB ADDRESS R b�v Ov 7 (y`�` 5 LOT# <br /> SUBDIVISION Z Wr5 - PARCEL ID# <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED- NEW CONSTR ADD/ALT SIGN Q MOVE 0 DEMOLISH <br /> B . INSTALL e REPAIR j <br /> PROPOSED USE Q SFR 0 COMM Q OTHER <br /> TYPE OF CONSTRUCTION Q BLOCK 0 FRAME 0 STEEL OTHER <br /> �. re-/��>c r�`( S GI�F shin les I.bla�l..l on <br /> DESCRIPTION OF WORK <br /> BUILDING SIZE. <br /> a l UU 5 SQ FOOTAGE HEIGHT <br /> BUILDING $ OSTS <br /> , VALUATION OF TOTAL CONSTRUCTION <br /> Q ELECTRICAL $ AMP SERVICE 0 PROGRESS ENERGY 0 W.R.E.G, <br /> PLUMBING $ <br /> 0 MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION b ' <br /> 0 GAS 0 ROOFING 0 SPECIALTY 0 OTHER <br /> FINISHED FLOOR ELEVATIONS I FLOOD ZONE AREA AYES QNO I <br /> _BUILDER.-. .: COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRENT YI /N 1 <br /> Address License# <br /> ELECTRICIAN COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRENT <br /> Address License# <br /> PLUMBER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRENT Y/N <br /> Address License# <br /> MECHANICAL COMPANY' <br /> SIGNATURE REGISTERED ' Y/ N FEE CURRENT Lyl N <br /> Address License <br /> # <br /> OTHER COMPANY <br /> SIGNATURE (� 1 REGISTERED Y N FEE CLTNRENT /N <br /> Address (pt{13 Sf- S y I `S J License# <br /> RESIDENTIAL Attach,(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction, <br /> Minimum ten(10)working days after submittal date. ,Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities&1 dumpster;Site Work Permit for subdivisions/large projects <br /> COMMERCIAL• Attach(3)sets of Building Plans;(1)set of Energy Forms.R-O-W Permit for new construction. <br /> Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities&1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance <br /> SIGN PERMIT Attach(2)sets of Engineered Plans. <br /> ****PROPERTY SURVEY required for all NEW construction. <br /> Directions: <br /> Fill out application completely. <br /> Owner&Contractor sign back of application,notarized <br /> If over$2500,a Notice of Commencement is required. (A/C upgrades over$5000) <br /> ** Agent(for the contractor)or Power of Attorney(for the owner)would be someone with notarized letter from owner authorizing same <br /> 'OVER THE COUNTER PERMITTING (Front of Application Only) <br /> Reroofs Sewers Service Upgrades. A/C Fences(Plot/Survey/Footage) <br /> Driveways-Not over Counter if on public roadways..needs ROW <br />