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08/31/2011 10:15 3525674454 MILBAR PAGE 01/05 <br /> 813•7An.fJ�2� City of Zephymills Permit Application Fax•a��-�so <br /> , Building.bspartmant � � Q� <br /> Oaha Rec�lv�ei' _ � � <br /> Phon� CoMee! for Pe+mktln <br /> �er's NAmo ' Owner Phon� Numbsr o�] � 1� <br /> Owner's Addross x�r+Mtu; 335i� <br /> � Owner Pfiono Numb�r � <br /> Feo S)mpb Tiqaholtler Name �J Owner Phone Mumlfsr <br /> Feo Slmplo Tkleholder Addrer� <br /> JOB ADDR�S3 ; � <br /> LOTO <br /> SUBDIVISION 1 (.v ( ppRCEL IDAt ,� <br /> (OBTNNEb FROM PIlOPERTV TAX NOTICE) <br /> WORK PROpOSED B NEW CON3TR � ADD/AlT � SICaN a MOVE Q DEMp1,ISH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SFR Q COMM � OTHER <br /> TYPE OF CONSTRUC710N Q BLOCK Q FRAME Q STEEL Q 07H6R <br /> AESCRIPTION OF WORK � J <br /> a c <br /> BUILDINti SI7.E ' SQ FOOTARE HEIGMT <br /> Q� BUfL01NG d VALUATION OF 70TAL CONS7RUC710N <br /> �,y� - J J <br /> [� ELECTRICAi, ¢�'�'� AMP SERVICE �, PROGRESS ENERGY � W.R.E,C, <br /> � <br /> � PLUMBING � , I (,� � . <br /> Q MECHANICAL S VALUATION OF MECHANICAI INSTALLATION � � <br /> o �..,. � Z31 � <br /> GAS ►i ~ ROOFING Q SPECIAL7Y Q OTHER � j <br /> FINI3MED FI.00F2 E4EVATIONS - FLOOp X01� AREA QYES �NO <br /> BUILDER ��o�. � COMPANY l� 1�I �! 147�1�1inc,__ � N <br /> SIGNATURE REOISTERED � FEE CURI! T y N � <br /> A� tsa�i u� sc�► �e G �� a 3 �� t�e�.��.��Z <br /> ELECTRICIAN � COMAP/lMY � <br /> sIONATURE ' aEO�eTeRl:a Y/ N i aEE cuRltiNr Y/ N <br /> Address l,benss �R <br /> PLUMBER � � C�AAPANY � <br /> SIGNA?URE I RE015TeR&0 Y! N i FEE CuRrtErn' Y! N <br /> Addro89 LIDe1190 il� � ! <br /> M6CNANICAI: COMPANY � <br /> �iNATURE REOI87ERED „Y / N FEE CURRENT V I N <br /> Adtlrase I.Icensa ie <br /> OTHER COMPANY ' <br /> SIGNATURe � REGI7!'EREA _ Y/ P! FEE CURtiENT Y/ N <br /> Address Lfconae i <br /> RES{DENTIi4L Atl9Ch (2) Pld PIlNtb; (2) iafs ot 8uikpng Plans; (1) �et Of Enefyy Form9 <br /> MMlmum ten (10) wqrking days after submitlfd date. Requlred onsite, Constructbn Pians, Sanitary FacilHks 8 1 Qumpsler <br /> COMMERCIAL Attach (3) Sete of BuYtling Pkln�; (1) set Of En@Igy Forms. <br /> Minimu�n ten (10) wo�king days aTOe� submtttal date. Required onslfe, Constn�ctbn Plans,� Sankary Fadlilias 8 1 dumpster <br /> AII comme►clel roquirementa musl meet compllance. <br /> SIGN PERMIT nttach (2) aetc oi Englneerad Plans. <br /> •"`PROPERTY SURVEY requited for all NE1N construCtlon. <br /> recdons: <br /> Fm out appncation comWetey. , <br /> Owner 6 Contrudor sign baek ot eppllcotbn, notarizad <br /> If ove� 5�500, a Notic� of Cemmsr�cemQn! Is roqulred. (MC upqtades ovo� E6000) <br /> ° Agent (tor the contraGor) or Power ot Attorneq (torlhs ovimer) would be someone wkh�nolarized letter irom owner autiinrizing aame <br /> OVER THE COUNTER F�ItMITTING {Front o1 AFpliCatlo� Only) - ? � � <br /> Reroofs Seweis � Sen�ice Upgr�des ,4/C Fences (PIOUSurveylFootape)' •- <br /> DMvawaya-Not over COUn1eNf on,public ro�dways„neetlS ROW' " <br />