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<br />Building Department
<br />
<br />I c.lA-u I ...F I U,ru'vi:.. I
<br />
<br />DatI) 'Received
<br />
<br />
<br />OWner's Name
<br />
<br />Fee Simple Titleholder Addrell I
<br />
<br />I<~,(;)\~ ~t\. \'k~ ~ ~~~~ I lOTti' ~
<br />~~\ \-<<'\""C~ I PARCEL 10#12>\ ~~\"'~~"<<D ~~ I
<br />~ ' (OBTAINED FROM PROPERTY TAX NOTICE)
<br />WORK PROPOSED ~~W CONSTR ~D/Al T 0 SIGN 0 MOVE D DEMOLISH
<br />
<br />PROPOSED USE 0 ~~;ALl 0 :~~R. 0 OTHER ~
<br />TYPE OF CONSTRUCTION B K' D' FRAM . 0 STEEL ,OT R I
<br />
<br />DESCRlPTlONO.WORK ~~\.~ \~~\\~'\.:- - - _ __- _
<br />
<br />
<br />
<br />
<br />
<br />o PLUMBING 1$ I
<br />
<br />o MECHANICAL 1$ I
<br />
<br />o GAS 0 ROOFING D
<br />FINISHED FLOOR ELEVATIONS I I
<br />
<br />Owner Phone Number
<br />
<br />Owner Phone Number I
<br />
<br />Owner Phone Numb~r I
<br />
<br />Own.'.Add.... h'~s\~~~~ '()
<br />
<br />Fee Simple Titleholder Nam ,
<br />
<br />JOB ADDRESS
<br />
<br />SUBDIVISION
<br />
<br />AMP SERVICE
<br />
<br />D
<br />
<br />PROGRESS ENERGY \ D t:::~~,
<br />----J,a ~\~,
<br />
<br />VALUATION OF MECHANICAL INSTALLATION
<br />
<br />fJOC-
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<br />q-ll f07
<br />
<br />COMMERCIAL
<br />
<br />Address
<br />
<br />MECHANICAL I
<br />SIGNATURE .
<br />
<br />Address I
<br />
<br />OTHER I
<br />SIGNATURE
<br />
<br />Add",.. l . . I u",,, . I I
<br />
<br />1'1"1"'1"'1'111111'111'1'11"'1'111111111111111111'111111111111111111"1'11,111111111111111111'111'1""11'1'11"1'1111111"11111'11'1111'1'1111
<br />RESIDENTIAL Attach (2) Plot Planl;(2) seta ofBulidlrig Plans; (1) set of Energy Fonns
<br />Minimum ten (10) working day. after 8ubmlttal date. Required onslte, Construction Plans, Sanitary Facilities & 1 dumpster
<br />' Attach (3) sets of BulldlngPlanl; (1) .et of Energy Fonns,
<br />Minimum ten (10) WOrf<lng day, after8ubmlttal date. Required onslte, Construction Plans, Sanitary Facilities & 1 dumpster
<br />All commercial requlremenll mUlt meet compliance.
<br />Attach (2) sets of Engineered Plan.,
<br />....PROPERTY.SURVEY required for all NEW construotlon,
<br />
<br />BUILDER
<br />SIGNATURE I N Y I N
<br />Add'~'S~~. b~ U"'".. ~C'\":-, ----Cl'~~ i
<br />ELECTRIC .' 0 ~NY I\-, ~~\f \~ I
<br />SIGNATURE . - -- ~- - . - R'Gl8TEI<ED ~~ ",ii:"...", I Y I N I
<br />Address I I License # I \ ~ 'I I
<br />
<br />=~U.:'A~~E I ;.~:r;:~ Y IN,,, CURRENT Y I N i
<br />
<br />r license # I
<br />I
<br />
<br />I
<br />I
<br />
<br />
<br />SPECIALTY 0
<br />FLOOD ZONE AREAO
<br />, S
<br />
<br />OTHER
<br />DYES
<br />
<br />DNO
<br />
<br />COMPANY l
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />FEE CURRENT
<br />
<br />Y/N
<br />
<br />License #
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y I N
<br />
<br />FEE CURRENT
<br />
<br />Y/N
<br />
<br />SIGN PERMIT
<br />
<br />111,.I.III.IIII.I.I,I.I.II,IIIIII.,.I.I."I.II.,.,llll1'.,,1.1.1,,111.,.,.,.1.111.1.1,1111,1111111111,1,11,1.1.,,11,111111.,11,.111,111.1.11111,,11
<br />Directions:
<br />Fill out application completely.
<br />Owner & Contractor sign back of application, notarized
<br />If over $2500, a Notice of Commencement II required. (AlC upgrades over $5000)
<br />
<br />Agent (for ltle contractor) or Power of Attorney (for ltle owner) would be someone wfltl notarized letter from owner authorizing same
<br />
<br />OVER THE COUNTER PERMITTING (Front of Application Only)
<br />Reroofs Sewers Service Upgrades NC Driveways Fences (Plot/Survey/Footage)
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