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Date FteceivE;d <br /> } Phone Contact for Permittin 13 S Z-6q "13(.� <br /> 232�2T,232'.CGISm .®�:��'2fl�� <br /> Owner'sNama; 1 �( �QiTQtGk.: _ 0wrieeP1hon6:M1lu er $ '7g'r2,'' t'lr dC2 <br /> Ownee's Addr}ss)[3. owner Phone Number <br /> Fee t>impie Titleholder iName Owner Phone hlurrtber <br /> Fee Simpie Tltlet)older Address <br /> ,FOB ADDREst� I 3 S`'f 41(a G a1Ta N oo G. Ze 0+0 �►� �S F ly LOT <br /> SUBDIVISION Gt vO-P za4mvils 'PARCEL 0210 -.0000n. • old <br /> (OSTAINE:D FROM PROPERTY TAX NOTICE). r <br /> WORN:PROPOSED E <br /> NEW CClNS1'R 1� ADD/ALT C7] SIGNDEMOLISH <br /> INSTALL REPAIR r� <br /> PROPOSED USSEi C� SFR. I� COMM OTHER (_ 1 <br /> TYPE: OF CcONSTRi.IGTION BLOCK FRAME,' , C_�. I. STEEL <br /> DESC1RiPTIO'N Oi;WORN: 1440- 114MJ—� <br /> i <br /> 3UILDING SIZE _ �; SSQ FOOTAGE HEIGHT [_�) <br /> [ FSUSLIDiNCi VALUATION 01:TOTAL CONSTRUCTION <br /> E:Li=CTkICAL. ($ AMP SERVICE F7 PROGRESS;ENER6)Y. C] W.R.EE.C. <br /> [ �PLUMBIL <br /> [.-7MECHA�1t,AL ($ VALUATION Of MECHANICAL lNSTALLATIC�N- <br /> GAS ` C� ' ROOFING SPECIALTY Cr] OTHER <br /> INISFIED FLOOR EEL.EVA'rIONS FLOW ZONE AREA =]YES NO <br /> H+ti-H ti Ftftitttii-Fit t tiff tt t ttti ti-ti-Ft i t Ft-it <br /> UILICIER TT- <br /> (?MPANY 1"�'b fti 4M�itki t1 ti htHHf hit 1 ki httt4t ti t Hkt t t I t fit t t tttttl-htfi t FH-M titti-FFtii 1 <br /> QI , Te. L,Lc. <br /> i frl - <br /> IGNATURE �.d� llot4{ G"Ito _ REGISTERED �Y i�tV FeE CURREt+•2 � Y'(t/�I <br /> ,Address �4')o C340�L "1$ 1�R 3 ,�I Ars �� 3 z8? t Liceit a#' ��o yi 7 <br /> _ECTRICIAN _I. COMPANY <br /> GN ATURii: _ _ REGISTERED Y/ N T FEE GU(RR�EE Y`! <br /> Address Licen e# <br /> .UMBER COMPANY• <br /> 3NATURE { I «� REGISTERED Y/ N r FfE GURREA <br /> Address L_L.�: Llcens�# <br /> :CFt�4NtCAL ) COMPANY _�_f <br /> 3N,ATUREi I r REGISTERED Y/ N FEi CURREA <br /> Address I License# <br /> HEIR _- i COMPANY' r. I <br /> iN,ATURE REGISTERED FE cURREM1 N�Y/ <br /> _ <br /> Address C_I __ Licensm <br /> FH-f 11111 i� H+f i;i- t •ti-f-H-!•ttkt+tHi t 111 Ht tti•H H ti t i-H i i i 1+HH+ii i Ftf ti+t f fi F t <br /> SID ENTiAi_ Attach(2)Plot Plans;(2);sets of Building Plans;(1)set 0 Energy Forms;R-O-W Permit for new construction, - <br /> lAnlmum ten(16)workinil days►her submittal date. Required onsite,Con'st16cilon' Plans,Storm water Plans wi Silt Fence installed, <br /> Sanitary Facilities&1 du: Aster:;Site Work Permit for subdivlslons/Dirge projects <br /> MMERCiAL Attach(3)complete sets of Building glans plus a Life Safety Page;('!)pet:of Energy F'orms.lEt-O-W Permit for nE)w.Cbnstruct!on._- ---- <br /> MI'h!murn ter,(10)wotking2lays,�ftbr u6brritiai data. f2equirad onsite,Construction Plans,Stormwater Plans w/'Silt Fence Installed, <br /> Sanitary Facilities&1 duinpster.Site Work Permit for all now projects.Allicommerclal requirements must meet.complfanca <br /> N PERMIT Atfach(2)sets of Engine6red Plans. <br /> """PROPERTY SURVEY required for all NEW construction. <br /> 73IIZLT.L��1Ta3�tli�Itl7��xt� t7�ILltrli�iItI; �ILC� XCLB <br /> 1clions: <br /> Fill out application completely. <br /> Owner&Contractor sign back of application,notarized ? 7 <br /> P over$2500,a Notice of Commencement is required. (A/C upgrades over t$7500) i <br /> Agent(for the cc) tractor)or Power of Attorney(for the owner)would be someone with,notarized,letter from,owner authorizing same- <br /> :R.'rHE COUNTER PEROTTING) (l=ront of Application Only) <br /> tofu,if shingle=; ; Sewers Service Upgrades A/C Fences(P1ot/Survey/Footage). <br /> DtIvewayts-Not over Counter if on public`roadways-needs ROW <br /> I <br /> i <br />