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Q Building Department <br /> Date Received phone Contact for Permitting <br /> Owner's Name, d d V vCL' U Owner Phone Number 1 .``V 'y�•� "'" <br /> Owner's Address Owner Phone Number <br /> F. <br /> Fee Simple Titleholder Name Owner Phone-Number <br /> Fee Simple Titleholder'Address <br /> JOB ADDRESS I ��sl 335�f a LO. 9 <br /> C Z bgoo 6USUBDNISION ; L (( � Q <br /> ,._.- <br /> ' ' (OBTAINED FROM PROPERTY TAX NOTICE) " <br /> WOR!S PROP,OSED_'' NEW CONSTR ADDIALT �SIGN Q MOVE Q DEMOLISH <br /> , <br /> INSTALL REPAIR � <br /> fa <br /> PROPOSED USE Q .SFR, 0 COMM Q OTHER <br /> TYPE OF CONSTRUCTION' Q BLOCK 0 FRAMME,J (QI STEEEL Q OTHER <br /> DESCRIFTIONOF,WORK; ��� 0 I��-(0OP S I' IUWt�e(� ITUY1Q�l �xS�BO�( : - <br /> BUILDING SIZE Ud. 10.607AG . HEIGHT <br /> BUILDING <br /> VALUATION OE:TOTQL CONSTRUCTION <br /> Q ELECTRICAL $ AMP SERVICE PROGRESS ENERGY Q ,W.R.E.C. <br /> Q PLUMBING $ <br /> Q MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION <br /> Q GAS Q ROOFING Q SPECIALTY Q OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES =NO <br /> BUILDER.. COMPANY <br /> SIGNATURE REGISTERED 1, Y/ N •':FEEcuRREr{r, 'Y/N <br /> Address Ucense it <br /> ' <br /> ELECTRICIAN COMPANY <br /> SIGNATURE REGISTERED I Y/ N 'FEE,CURRENT "'Y'/N <br /> Address License# <br /> PLUMBER COMPANY <br /> SIGNATURE REGISTERED Y/N' FEE CURRENT":'' �Y/N <br /> I <br /> Address License# <br /> MECHANICAL COMPANY <br /> SIGNATURE 'REGISTERED Y/ N FEE CURRENT Y/N <br /> Address License nn# <br /> ;OTHER <br /> SIGNATURE " <br /> // n 11 rr uREGISTERED N ' FEE CURRANT' /'N . <br /> Address l0' 3 S 2 S`T h;�l S (- 33 S I (`License# LCCC,I 550 S <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(16)working days after submittal date.,Required onsite,Construction Plans,Stormwater Plans w/Slit Fence installed, <br /> Sanitary Facilities&1 dumDster Site Work Permit for subdivislonsllarae orolects . , <br /> I <br />