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Building Department <br /> ;te Received /l r-),,—`� <br /> Phone Contact for Permitting <br /> wner's Name Ra c 4o fl'l C N M )G(.il c, (,.L Owner Phone Number 6 10 `1 •✓ (ej <br /> wner's Address �ll(<?Z S' r�1 Il l���r G 1 I iV fib)f2(� L Owner Phone Number <br /> m Simple Titleholder Name /A Owner Phone Number <br /> :e Simple Titleholder Address WA <br /> 06 ADDRESS LOT# <br /> USDIVtSION Fo(;ics PARCEL ID# Oq-Ot 419 —RI <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> IORK PROPOSED ® NEW CONSTR 8 ADDIALT SIGN [] �] DEMOLISH <br /> INSTALL REPAIR <br /> ROPOSED USE 0 SFR. = COMM OTHER <br /> fPE OF CONSTRUCTION RJ BLOCK FRAME STEEL 0 <br /> ESCRIPTION OF WORK <br /> UILDING SIZE -row SQ FOOTAGE HEIGHT CN = = __ <br /> BUILDING $ _ -- 4� VALUATION OF TOTAL CONSTRUCTION <br /> =ELECTRICAL AMP SERVICE -�P/ROOGRESS ENERGY Q W.R.E.C. <br /> =PLUMBING J$ t DD <br /> =MECHANICAL $ r1 OD VALUATION OF MECHANICAL INSTALLATION <br /> oC <br /> =GAS = ROOFING 0 SPECIALTY = OTHER �(R <br /> 1NISHED FLOOR ELEVATIONS FLOOD ZONE AREA OYES N0 <br /> WILDER COMPANY <br /> ,IGNATURELUI-I <br /> REGISTERED Y/ N FEE CURREN Y/N <br /> Address �I a0�r/1 S T4.lket197.Eaq ��;tle wl r t-,339VI License# 1 616c,a <br /> ELECTRICIAN COMPANY <br /> SGNATURE REGISTERED Y/ N FEE CURREN Y/N <br /> i�' Z 1 I1 tCG 10/1(4r� a/Y Z, L <br /> Address License,#-1��� 3 ` ) <br /> N <br /> SLUMBER COMPANY v I'/ <br /> SIGNATURE p REGISTERED Y FEE CURREN Y/`N <br /> Address 3/33�/� 37� �l GJrla`& ' <br /> ,F�3 W6 License# � ��'?a 7a-7-7 <br /> MECHANICAL COMPANY /IDLS <br /> SIGNATURE REGISTERED Y/ N._J FEE CURREN Y I N <br /> .Address HVI� G�SL�1,F(� 3 c:j(4a l License# F d A( tg 3 iz) I <br /> OTHER COMPANY 61�"coew aL C' <br /> SIGNATURE p, REGISTERED Y/ N FEE CURREN Y I N <br /> Address /'i93J�/Y//n A- Ply). Xf /c/7 "�IC�,3 License# <br /> QAeAeA .Awes ® e.>IeeeuAA >< eArr 'aeesll< aoea >teeAnaeaA >I >< >leeA >I >< eooea9e9teeee >E" aeoe' <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.Eriergy 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 /> Driveways-Not over Counter if on public roadways..needs ROW <br />