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Date Receive.dl i 3 GC/GV Phone Contact for Permittin �at� _��7.6$•q a f'e�'�� <br /> xxtaxxrxErt�xm :®7�i: ZtL =rT = <br /> Owner's Name I R�IJm Jiti(S' Y� Owrier Ptione ISIU ber <br /> Owner's Addreso C 6_30 14ci4di 1ar3—Will$ Owner Phone Number 1/3— 7/S=-2_=4 <br /> Fee 8Imple 1'Ittetioicrer Name! C ! � �' �s�� Owner Phone <br /> Fee dimple Titletlolder Address <br /> JOB ADDRESS i �_+to1424 !i4ury'�';N9Tonl p�R Ze.Pt+�Ri►t`us _F 3"lSy�.� LOT# <br /> suBraivtstoN L � A 614;t S, PAReEL tD#�=U. -x .-dL2Lf2(OBTAINED FROM PROPERTY TAX NOTiCIi). <br /> WORK PROPOSED S NEW'CONSl'R C;ADD/ART . ,] i SIGN '_= : C`i ,DEMOLISH <br /> El, INSTALL ' I I REPAIR I <br /> PROPOSED USE! SFR C comM- C-� ` oTTH4Ft <br /> TYPE:OF C;ONSTRi1C'rION BLOCK i� FRAME. C�'� STEEL <br /> DESCIRiPTION 01-WORN: C � � '�' ',�" � I �`S7d•2 _ r� <br /> I <br /> 3UiLDiNG SIZE: ISQ FOOTAt3E: HE It3H r' <br /> zx��a�raa�x�xc�c r.�cExx�E�xtx��r�r-u�zxru�t�tr.� ;ta�i�� a�i�ca�t �uzuxa <br /> [ ]EyUIL101Nt3 3Y06. 70 VALUATION OF TOTAL.CONSTRUCTION , <br /> [_7E:LI_CTF6('AL. ($ —�� AMP SERVICE FIRPGRESS:ENERC)Y:' C. W.R.E:.C. <br /> Lly � <br /> [._71VIECHANICAL $ VALUATION OF MECHANICAL-'iNSTALL.ATidN <br /> [_ GAS R06FING SPECIALTY C_] OTHER <br /> INISHED FLOOR E:LEVATiONS FLOOD ZONE AREA =]YES 1 NO <br /> I " <br /> ti tti-tti ti't t i-t Ftt-tittf ti tt (t It .......ti'tt ttl I-t t;t-H t1tf-HHttf H+H_H ttzH "H tit 11 ltH+11ifff tfi-I1i FH-Hit +H*H-i <br /> UILIDER _ Gt)MPANY Epp►. 146nie, Ce TP-fZ, LLL _ <br /> IGNATURE � oNi`ti XIZ0 REGISTERED /�tJ F-E CURREN Y JY(Pr 1 .i <br /> ,address scot -181 C) :tA 9c. '32Q7�t L.IcenE#e# C�� 15*0���f/.7 <br /> _EC.'1'RICIAIV Gt)MPANY <br /> GN.ATURI:. REGISTERED Y/ N T FEE CURREi< <br /> A+ddress �.� License <br /> .UMBER i COMPANY ���..._.. <br /> 3NATURE _(_� 1 REGISTERED. Y J N T_ F 1H CI' URREN <br /> Address [_i - Llcense# <br /> :CHi4NICAt COMPANY <br /> `sNATURE: _ _ REGISTERED Y.'/ N r FEi CU}2REA <br /> Address [_f _ Liconb�# <br /> HEiiFt I <br /> i i I COMPANYC _o1N,4TURE —_____� ________ REGISTERED Y! N r . Fr_EE cuRREn <br /> Address L_��_ _ License# .__.,.� <br /> Hi-tttiii�i�th}i t1tl��t t 4 Hat H+H-11 hh1 111 t f 1.141 f+H+1-t-H-ttf Ff li-Hi�t�t+ti ti t1 ti+HF H-Ft�t-Fi-t�Ft1•t+t-i-Hf H, i F till t-t-i E t t tti-tiiii+t H tt1 H tifii hat <br /> SiDtENTiAE. . Attach(2}Plot Pions;(2)'sets of Building Plans;(1)set of Energy Forms;,R-O-W Permit foi.-new construction, <br /> M(hlmum ten(10)working)days;after submittal data, Required onsite,Construotlon Plans,Stormwater Plans w/Silt Fence Installed, <br /> Sanitary Facilities&1 duinpster,Site Work Permit for subdivtslons/large protects <br /> MtnERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(1),set of Energy F'orms'.lR-O-W Permit for new-cbnstruction._ <br /> Minimum ten(10)working days after.oubmittal date;-Required onsite"Constructlon Plans,Stormwater Plans w/Silt Fence Installed, <br /> Sanitary Facilities&1 dutnpster.Site Work Permit for all new projects.All=mmerclal requiriements must meet-compliance <br /> N PERMIT Attach(2)sets of I3ngineeired Plans. <br /> "ItIPROPERTY SURVEY.requlred for all NEW construction. <br /> XtxzSLCL%�ZI73xtIt�CiZ77�i1�tlLt�i�Iu7»tg:' 1�CLl�l �ll:p�'**TM'r'w''� �f2E <br /> tctlons; <br /> Fill out applicatlon completely..: <br /> Owner&Contractor sign back'of appi[oatlon,notarized- <br /> llt over$2500,it 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 /> :R.THE COUNTER PEEIRIMITTING (1=ront of Application Only) <br /> ,of=,if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage) <br /> DrIvewayps-Not over Counter if on public'Toadways-ri0eds ROW <br />