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` <br /> ^ <br /> 0,110 Received <br /> Owner's Name 1. In Owner a umber 8c)—ISM <br /> FOLSImpla Titleholder Name Owner P one lumber <br /> FeeSimpla <br /> WORK PROPOSER) NEW CONSTR ADD/ALT SIGN DEMOLISH <br /> E3 INSTALL REPAIR <br /> TYPE OF C ONSTRUCTION BLOCK FRAME Sl.-EE� <br /> JOB ADDRESS LOT# <br /> BUI <br /> | <br /> ~ — VAt.UATION OF TOTAL.CONSTRU <br /> Fi�OGRESS ENERGY WR,I'.,C, <br /> L.:DELJECTRICAL. AMP SERVICE <br /> ['7MECHANICAL VALUATION OF MECHANICAL INST LLA ION <br /> r,;i3HE-Df--LO0R E:t.EvxrlONS FLOOD ZONE AREA ]YRS NO <br /> it <br /> Addrar;s e),)t L�Shp 4�4- L.Icinue it <br /> GNATI <br /> Lice�Sa It <br /> ikddress Lire se# <br /> =" ..~-~.. <br /> INA <br /> Address <br /> --- <br /> 14 <br /> ........ ..... ........—..-------� � <br /> 31"EN.~^ Atinch(2)Plot Plans;(2)sets of QuIldIng Plans;(1)set of Energy Porm":R-O-W P(milt 1�r hew construction, <br /> M m � . <br /> � <br /> � <br /> ~~~~~~'(10)working days after Submittal date. Required onslia,Construction'Plans I Stotmwater Plans w/Silt Pence Installed, <br />