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s�3aso-oo2o Lity oT Gepnyrnins rer����� r+NN���Q����� <br /> Building Departmenf <br /> Date Received <br /> - ?j ' ' Phone Contact for Permitting �l �oa - �a`�`" <br /> . ��3- ��f - 9��oy <br /> Owner's Name �/�/k � n� Owner Phone Number <br /> Owner's Address S y �° � Owner Phone Number <br /> Fee Simple Titleholder Name <br /> Owner Phone Nurriber <br /> Fee Simple Titleholder Address �� <br /> JOB ADDRESS <br /> .r y3O l d' "' f LOT # �i <br /> � f� / <br /> SUBDIVISION 6'F I�/�.� PARCEL ID# � �' a � / <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED � NEW CONSTR e ADD/ALT 0 SIGN Q MOVE 0 DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE 0 <br /> SFR � - COMM [� OTHER <br /> TYPE OF CONSTRUCTION 0 BLOCK 0 FRAME � STEEL 0 OTHER <br /> DESCRIPTION OF WORK ��-�- ���m � e "' " -' <br /> BUILDING SIZE !y ( 6�� u��" SQ FOOTAGE � 7 7 HEIGHT <br /> � BUILDING $ s — ' y�� , �U �+ VALUATION OF TOTAL CONSTRUCTION <br /> � ELECTRICAL $ AMP SERVICE [� PROGRESS ENE�Y �] W.R.E.C. <br /> y�S. � <br /> 0 PLUMBING $ � 1�i ""� � <br /> PAS00 rEAMIT a�RVICE <br /> � MECHANICAL $ VALUATION OF MECHANICAL INS7ALLATION (�3� 788-5314 <br /> FAX 1-896-824-7894� <br /> � GAS Q ROOFING 0 SPECIALTY � OTHER I I�� � <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES ONO �/ <br /> d� <br /> BUILDER c �� �� � � � COMPANY � • � ' " f OC Z/t�C . <br /> SIGNATURE ���� / ��� REGISTERED Y/ N FEE CURRENT Y/ N <br /> Address `���� �� � r License# <br /> ELECTRICIAN �� (" �� (�� ��a��� , ,/, �l� �+� COMPANY �C.(:l�Le. �G�G�7�'l•C <br /> 1VL�t, v�-7�'`� REGISTERED Y! N FEE CURRENT Y/ N <br /> SIGNATURE <br /> Address P ' � • � Ux d � � � r �s"� License # <br /> PLUMBER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRENT Y I N <br /> Address License # � <br /> MECHANICAL COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRENT Y/ N <br /> Address License # <br /> OTHER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRENT Y/ N <br /> Address License # <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 subdivisionsllarge projects <br /> COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R-O-W Permit for new construction. <br /> Minimum ten (10) working days after submittai 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. (AlC upgrades over $5000) <br /> ** Agent (for the contractor) or Power of P;ttorney (for the owner) would be someone with notarized letter from owner authorizing same <br /> OVER THE COUNTER PERMITTING (Front of Application Only) <br /> Reroofs Sewers Service.Upgrades A/C Fences (PIoUSurvey/Footage) <br /> Driveways-Not over Counter if on public roadways..needs ROW <br />