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<br />Ol';)-/~U <br /> <br />~IlY UI LtlptIY"1ll1:i ....ttllllll MJJVI",,"UUII <br />BuIlding Depertment <br /> <br />{)~,-'! I ~ ~ .:j:t- '3 <br /> <br />--m ~__"~M?J <br />......._ ".., liJ,~M. rSh~h(\ . - i3 q71 -ZYS"7 <br />.......- Il.fh e (,,.11 ijQ. U,*,,,J,, /It .....--1 I <br />Fft SImple TllIehoIcIer IUme I ~ (V' , Owner Phone Number I I <br />. ,.. ~ <br /> <br /> <br />JOB ADDRESS <br /> <br />SUBDIVISION <br /> <br />WORK PROPOSED <br /> <br />DEMOliSH <br /> <br />PROPOSED USE <br />TYPE OF CONSTRUCTION <br /> <br />CJ <br />o <br />liLt- <br />BUILDING SIZE Uo 0 r 'I So f I sa FOOTAGE 13 oDD <br /> <br />t2k.11 '5 DD <br />1$ Lf-c> , 000 <br />I$Q550 <br />MECHANICAL ~J, 7 DO <br />GAS ROOFING <br />FINISHED FLOOR ELEVA1IOHS U I ' <br /> <br />="'- r~V..-. 1== <br />~ l.;t~ II D Sa.. 54. Jh.JD<.. Lvi%- 'Pt. <br />~a <br /> <br />DESCRIPTION OF WORK <br /> <br />o <br />o <br />o <br />o <br />~ <br /> <br />BUIlDING <br /> <br />ELECTRICAL <br /> <br />VALUAllON OF TOTAL CONSTRUCllON <br />AMP SERVICE ~ PROGRESS ENERGY <br /> <br />D <br /> <br />W.RE.C. <br /> <br />PLUMBING <br /> <br />VALUATION OF MECHANICAL INSTALlATION <br /> <br />CJ <br />I <br /> <br />SPECIALlY D <br />FLOOD ZONE AREA <br /> <br />OTHER <br />DYES <br /> <br />rzrr;; <br /> <br />ELECTRICIAN <br />SIGNATURE <br />;)'7(01;)- p~S~~r~. <br />..:Je..~I.E.i1 C::iCA~~~j f<j3~H <br />PLUII8ER <br />SIGNATURE ~ <br />A~ /3B 744 CR. S'H <br /> <br />~I <br />~I <br />=TURE/ <br />Addras I <br /> <br /> <br />COMPANY <br /> <br />I Yt;j (~d:iJ~ ~e1siC~s <br />Licensd I c.6:C 05 ~ 112..1 <br />If' ~c...+Gfz-I~~C- <br />~~.. ~"'P""~~ 1A <br />YI N FEE~ IN <br /> <br />1.il3IR. ~..........~ 1~<6 -I ri...c.U~X>I~b3 <br /> <br />(\~ W.'ho. m<.> -nc.. <br />N FEE~ N <br /> <br /> <br />l-I-I.lI~ I~ <br /> <br />I.il3IR . <br /> <br />COMPANY <br />REGISTERED <br /> <br />L.rl.lL.I FEE CURRENT <br />1.il3IR. I <br /> <br />U!!LJ <br /> <br />COMPANY <br />~1t:ta:U <br /> <br />I VIN I FEE~ <br />Licens8 6\ I <br /> <br />U!!LJ <br /> <br />RESIDEN1IAl. AII8ch (2) Plot Pl8n8; (2) sets d Building Pl8n8; (1) set d Energy Forms <br />MinImu'n \en (10) ~ d8ys 8fter 8Ubmillal d8t8. Reqund onsiIe, ConsIruclion Plans, SeniIery Feci1iti8s & 1 cUnpster <br />COIIIIERaAL AIlach (3) sets d Building P*-; (1) ll8l d Energy Forms. <br />Mlnillum \en (10) ~ d8ys ell8r submlIIaI dale. Required onsiI8. ConsIruclion PIens. SeniIery Fecilities & 1 dLmpBIer <br />All COlllI'II8R:ilI ~ musl meet compIi8nce. <br />SIGN PERMIT AII8ch (2) sets d Engineered PIIns. <br />""""PROPERTY SURVEY reqund for ell NEW CllI'IIIlnldion. <br /> <br />D1nlCt1ons: <br />Fill out eppIiceIion camplelely. <br />Owner & Conlrector lIign b8ck d appIicIItion, nol8riz8d <br />If........ $2IlGO, . Nollce of c....-.tla noqu/nld. (Ale......... _ $IOCIOJ <br />- Agent (for Ihe lllII'IIracIor) or Power d AtIomey (for Ihe owner) would bll somllOl'l8wilh nol8riz8d IelIBr frnm ......... 8UIhorizing ...... <br />OVER ntE COUNTER PERIIIT11NG (Front d AppliceIion Only) <br />Reroors s-s Service lJpgrlldes AIC FlIIlC8Il (PloIISurYeylFootage) <br /> <br />~ over CounI8r If an pWlUc roadweys..needs ROW <br />