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O tJ-10U-Uvty Ll ty V1 z_VF1 I y I i 1111,7 I %I I I I I L I%V I-- . <br /> Building Department <br /> Date Received Phone Contact for Permitting w� — � <br /> Owner's NamelDr. G I to, e,4,) �piwpoj di Usti/ 1 Fric " Owner Phone Number Jqt13 <br /> Owner's AddressBSS I u► '{r,�f ii Owner Phone Number <br /> Fee Simple Titleholder Name Owner Phone Number <br /> Fee Simple Titleholder Address !! ii-- ` (' 2 t <br /> JOB ADDRESS 5��S tD fit {fl Ili 1 S I' }cS i t LOT# <br /> SUBDIVISION . PARCEL ID# 601 -.05 60D -C01..b <br /> (OBTAINED FROM PROPERTYTAX NOTICE) <br /> WORK PROPOSED'- R <br /> NEW CONSTR e ADD/ALT SIGN Q MOVE 0 DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE !aaQ SFR 0 COMM 0 OTHER I s �r <br /> TYPE OF CONSTRUCTION Q BLOCK aa II� FRAME 0 STEEL OTHER <br /> DESCRIPTION OF WORK t°� (rT ��-dL2(N C7t0Sq�ShtiZ���S Fill IORgd : If Ok4i't` <br /> BUILDING SIZE t�� S � �� ��� l U 84�1- <br /> SQ FOOTAGE HEIGHT <br /> BUILDING $ 1�� ft) Oitle� ( 2C <br /> VALUATION OF TOTAL CONSTRUCTION .,77 , <br /> [� ELECTRICAL $ AMP SERVICE PROGRESS ENERGY W.R.E. <br /> PLUMBING $ � • <br /> MECHANICAL ($ VALUATION OF MECHANICAL INSTALLATION <br /> GAS �� ROOFING SPECIALTY OTHER - <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES =NO <br /> !!!!III! "ItHv*lllilliliiaili!Riiiaiiiiiiiiiiiiiiaiiiiif <br /> BUILDER COMPANY <br /> SIGNATURE I REGISTERED Y/ N FEE CURRENT YY//N ) <br /> Address License# <br /> ELECTRICIAN COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRENT Y/N <br /> Address License# <br /> PLUMBER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRENT L=N <br /> Address License# <br /> MECHANICAL COMPANY <br /> SIGNATURE REGISTERED Y/ N ]� FEE CURRENT <br /> Address License# <br /> OTHER , r�/ COMPANY [R� 0 a �t. <br /> SIGNATURE U�✓ \ REGISTERED N • FEE CU ENT Y N <br /> Address eoq( it {r)t I I-) F-1 3 3 I License# C l c (,,,ic 55C)5 <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'requlred 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. (AIC 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 />