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Date Received Phone Contact for Permitting <br /> Owner's Name h = LL C- Owner Phone Number <br /> '711.2 fZ¢ad i ea v.k+13D <br /> Owner's Address L. Owner Phone Number <br /> Fee Simple Titleholder Name 7 Owner Phone Number <br /> Fee Simple Titleholder Addres'7' 1- 1 <br /> JOB ADDRESS QTAU - �OIJ QXd I'L 1 1� 16 �3 79 -L LOT# <br /> SUBDIVISION PARCEL ID# LO'Z�o Zl•0020.00flCA• Of��O <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED a NEW CONSTR® ADD/ALT = SIGN = = DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE = SFR 0 COMM = OTHER <br /> TYPE OF CONSTRUCTION = BLOCK �= FRAME = STEEL = <br /> DESCRIPTION OF WORK f�G7 �1C15T1, Gr r2 oca <br /> BUILDING SIZE I SO FOOTAGE= HEIGHT <br /> =BUILDING $ VALUATION OF TOTAL CONSTRUCTION <br /> FTIELECTRICAL $3'l D00, AMP SERVICE ® Q W.R.E.C. <br /> '1 DUKS <br /> =PLUMBING $ n r 9 <br /> =MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION <br /> =GAS ROOFING Q SPECIALTY = OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO <br /> BUILDER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE< Y/N <br /> Address License# -{ <br /> ELECTRICIAN COMPANY �e -m•-C.+ri C-o •Zl1C <br /> SIGNATURE Q� 1- REGISTERED Y N FEE CURREN LLUN <br /> Address <br /> License# C�r` <br /> G t30cw3 3 <br /> PLUMBER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE< Y/N <br /> Address I License# <br /> MECHANICAL COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURREt Y/N <br /> Address License# <br /> OTHER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURREN Y/N <br /> Address License# <br /> 1111111111111111111111111111111111111111111111111111111111111111111 <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(2)complete sets of Building Plans plus a Life Safety Page;(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$7500) <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 (copy of contract required) <br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage) <br />