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<br />Date Received <br /> <br />Owner'a Name B ro.....+z...... . ~ ..33~ I <br />I 3 ~ 3 4-0 ~ wocJ PI. 7... nh~' . Owner ?tIone Number <br />Owner's Address . ::::::J: _ <br />I .. 'I A- Owner Phone Number <br />Fee Slmple.T1tleholder Name IV <br /> <br /> <br />-~, <br />.---,- <br /> <br />. B~lIdlng Department <br /> <br />~ <br /> <br />Fee Simple Titleholder Addr... AI A <br />k3~3'+O Cofh,Y\wood. Pi, <br /> <br />~ ~h~' 10?-'~(P.;?I,O;;1./8, OOf-loO. 0050 <br />' ru..v-:> PARCEL 10# . <br />~ () f (OBTAINED FROM PROPERTY TAX NOnCE) <br />D NEW CONSTR c:::J D SIGN D MOVE D DEMOLISH <br />D INSTALL ~ <br />PROPOSED USE D SFR 0 <br />TYPE OF CONSTRUCTION 0 BLOCK 0 <br /> <br />f<c VI}&2- 7 w' <br /> <br />I <br />1$ ~,5~{t OS <br />1$ <br /> <br />JOB ADDRESS <br /> <br /> <br />I ...... i'.~~ <br /> <br />i,~ t~:,) <br />. .iI <br />. ~'''.'-i~;~;'r' <br />_ "::>!l,:.'\> <br /> <br />LOl# <br /> <br />SUBDIVISION <br /> <br />WORK PROPOSED <br /> <br /> <br />DESCRIPTION OF WORK <br /> <br />BUILDING SIZE <br /> <br />BUILDING <br /> <br />D <br /> <br />ELECTRICAL <br /> <br />PLUMBER <br />SIGNATURE .~ <br />Address <br />MECHANICAL <br />SIGNATURE <br />Addreal <br />OTHER <br />SIGNATURE <br />Addre.. <br />RESIDENTIAL <br />COMMERCIAL <br />SIGN PERMIT <br /> <br />Directions: <br />Fill out appllcaUon completely. <br />Owner & Contractor sIgn back of appllcaUon. notal1zed <br />If over $2500, a Notice of Commencement Is required. (AlC upgradee over $5000) <br /> <br />Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notal1zed lette <br /> <br />OVER THE COUNTER PERMmlNG (Front of AppllcaUon Only) <br />Reroofs Sewers Service Upgrades AlC Fences (PloVSurveyfFootage) <br /> <br />Drlvewsya-Not over Counter If on public roadways..needs ROW <br /> <br />111""""""1""""""""""""""11 <br /> <br />from owner authorizing same <br />