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wm R.osivaa � -( r+nw» contaee For y _�j <br /> �s � iJ � L 5 �.. �,«�. � 13� `l (, <br /> " OMmers Addross TT - C3 Owewr Phar Ih�nb�r - 1 <br /> '- Fae Simple TltlahWder Nama N OwNr Phar Numbw � <br /> Fee Siw�pis Tifblwldsr Ad�u � <br /> JOB ADDRE33 � �( �\ l UU LOT i� 1� <br /> sue� � 2 � C P��. �� • ai ��" ,- 0 5�> <br /> ,�,�.���.�„�T��, <br /> WORK PROPOSED � NEYy CONS7R e qpp/qLT Q SI(�J Q MpyE Q DEMOUSH <br /> INSTALL REPAIR <br /> PROPOSED USE � SFR � � � pTM� <br /> rne oF coNSix� C] s�oc�c [� Fwu� � s� p� or►� <br /> DESCItlPT10N OF WORIC � �� C � C.U� <br /> BUILDIDIG SIZE �(�� x , SQ F00T/1GE �� �, <br /> BUILDING S •' }+ `�D ' CL VALUATtON OF TOTAL CON$7}�C�ryp►r � Z j � l,C �� <br /> O( �'( �..� <br /> Q� ELECTRIGLL $ AMP SERVICE � ENERGY Q W,R.E.C. <br /> �' PIUMB�NG $ �- �/� � L <br /> � � <br /> MECHANICAL $ V/LLUATION OF MECHANICAL IN3TALtATION <br /> � cns Q ROOFlNG 0 sPECULLTV � on��x <br /> FINISHED ROOR ELEVATIONS FLOOD ZONE AREA QyES IO <br /> �. BUILDER �J COMPANY ��,r � � ' � � C �,?SG <br /> ' SIGNATUR - G"� r�c�ar�o �� J/�N� �cuRre�►�r ry <br /> Addrass n � . Z C� � Lkense i1 t '�jZ '�j c�-� � <br /> ELECTAICIAN COMPANY L 1�1.. �C "L �� <br /> 9KiNATURE ��� <br /> (� Y/ N FEE CUNRENT _ N <br /> nda� z- � ��� �� ��a �C� t"Z,�tl �� <br /> PLUNBER � COM � �[tS`� 1`.'l[�b� t� ��f�-IJZ <br /> SIGNATURE �. G <br /> Aad..ss (' ��C_. � ae # I l R l� L� �-1 C.) <br /> MECHANICAL J � fi CONPANY (,�M�( �� � � <br /> SIGNATURE L/,,,)%LC.- t/ r�cisiEREU / N � cur�rai ! N <br /> Address -�'_ 1 � �� � ' • '/ <br /> OTHER CQMp� �- � <br /> SIGNATURE r�cisieneo Y! N F� curtqEar Y 1 N <br /> Addresa LiCense i/ � � <br /> RE&DENTIAI Attad� (2) Pbt Plens: (2) aels d 6uildin7 P�an.s: (1) set d Fner9Y Forms: R-0�W P�it tor new a�on, <br /> Minimun ten (10) workkiD days aft� subrniCW dete. Rqquired onsiGe. ConsOn�ctlm Plar�s, � Plans w/ Sit Fence h�steNed, <br /> SarMary FedYdes 81 dump�ter 3ite Wak Pertd[ tor subdivlslor�eAerge P�ojects <br /> COMNERCIAL AUach (9) compb6e sels d Buiding Plana plus a Lde SafetY FeDe: ( I) set d Er� Fams. R-O-W Permit for new conetruction. <br /> M6�imum ien (10) workin9 deys �er aubmiltel date. ReqWred orrei0e. Ca�rokuctlon Plane. SrormwaEer Plens w/ SAt F� ir�teNed. <br /> ser�ary PawUee a 1 du�. siEe worlc PertNt rn. ax new projects. ar conrr�dal �ie� rt� �� <br /> 91CsN PERNfT Attach (2) eats d Engiiaered Pl�s. <br /> ""PROPERTY SURVEY requied Eor aN WEV1i canetr <br /> Diracebns: <br /> F�I out appGCaUon car�bely. <br /> Owner 8 Contractor aign back � appRceUOn. �imd <br /> N mror 52500. a Notke of Commeocom�nt ia requind. (IVC upyrsdu ovw f5000) <br /> " qgent (Tw the contradw) or Power d Ariomey (for the owner) would be sort�eone wMh noter¢ed letter kom owner auNwrizing same <br /> OVER THE COUNTER PERIIRTikIG {Front d Applicatlm pnly) <br /> Rerads Seweis 3ervica l�rades A!C Fences (PbtlSu^reYlFoote9e) <br /> DHvswaYa-►Jot o�rer Crnuuer it on Pubic roechwalrs..needs ROW <br />