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. a'�'ea°°z° , C" of <br /> �S' PhYfiills Permit Application �a,�-s�a��.00z� <br /> � / ��l .�� Bw7din9 �epartrnent <br /> U <br /> o�ts Rec�twd • � <br /> PhoM Cartact iw Permitdn <br /> �.� � rt � <br /> Ownsr Phons NumpK " .•� <br /> Owm►'s Addrp� O�j�' <br /> l. �irrisr Phone Numbar <br /> � s�mPM YtN�hoider Warr�e <br /> Own�r Phomt N�+m4�r <br /> Foe Simpi� TItI�hoMx Atldross <br /> JOB ADDRE53 � <br /> ('—�---- t LOT * <br /> SUBDIYISION I OG j G <br /> PARCELlDk �I � „ „ � <br /> WORK PROPOSED B ^_„( ��T�o � ►�ovEien'TAX NoTICgI <br /> NEWCONSTRB ADO/A�T i vi SIGN Q <br /> 1NSTALL �pqjR Q DEMOIISH <br /> PROPOSED U5E � SFR � COMM � OTHER <br /> 7YPE OF CONSIRUCTipN Q BLOCK [� FRAME [� S7EEL O ("--- <br /> —�� <br /> DESCPoPTION OF WORK {• � _ / � � � ��� <br /> J <br /> BIALt�It�G St2E SQ FOOTItGE � Z 1.=. C..ZN V��J �j <br /> t1EiGHT <br /> QBUlLDING �� - - —� `— <br /> VAtUATION OF TOTAL CONSTRUCTION <br /> QEIECTRICAI. ��'�"�"� � ��� /� <br /> ��__�__._._ <br /> Q PROGRES3 ENEitGY W.k.E.C. ��p� G(� <br /> QPIUMBIIV(� a <br /> �MECHATJICAL s X�� VALUATION OF MECHANICAI. INSTALLATiON �l ��l" �� <br /> 0 �� J �— ��.._ <br /> Q ROOFING [� Sp6C4V,Ty Q OTHER .�''�� -�` <br /> FINISHED FLOOR ELEVATIONS <br /> FLOOD ZONE AFtEA �YES NO � <br /> BUitDER �"'—'�' <br /> SIGNATthtE '�. —`� � COMPANY ` <br /> � T�o Y/ N FEE CURREn Y/ N <br /> Addrsas <br /> Uoense �M �_ � <br /> E��,� � �`� �c, 3 - � r <br /> SIGNq7'URE MPANY � � • <br /> REOIS7ERED Y/(J FEE tX1RRE1� Y/ N <br /> Addtess . y � �. <br /> l.icenae i <br /> P�,UMBER � <br /> SIGNATURE COMPANY <br /> �a Y/ N FEE CURREA Y 1 N <br /> Addroas <br /> ucense a� �� � D I� <br /> M�,�� rV � <br /> SICaNANRE COMPANY � ��'�J <br /> �Grs'r�o Y/ r�e amRen Y! N <br /> ,��.. � � �� ►�* -. , tn �u��� . � l� <br /> OTHER <br /> SIGNA7LRE COMPANY <br /> � REGMS7ERED V/ N FEE C.URRE� Y/ N <br /> Addtsss � <br /> II�III�IIIft11t�1111t/11111111111111111it111111'1�'j��1111� �11111 <br /> RESlDEM7AL Attach !Z) Piot Plans, (� aets W BuHdinp Plana; (t) ao1 of Energy Fams: R-aW Pertn� ior naw conatructlon, <br /> Minimum ten {7� woAcinG deYs afler aubmittW dete. Required onsite. ConsWction Plans, Stonnw�er Piens w! S8t Fence instaUed, <br /> Sanitary Fadtifias 3 1 dumpster; Site Work Pamtt fw subdiviaanaAarpe Prokas <br /> COMMERCIqL qBaqi (3) �pmplate aeW of Bu�7dinp Plans p!w a Li/e Safe(y Pa4e� (1) sei pf ��, Fortns. R-O-W Permk tor new cons�p�. <br /> Minimum fen (10) worW�G ��w aubmittffi data. Roqujred oneiU, Conakuction PiMa. Stomn�' Platls w/ S'rf! Ferxx instelbd. <br /> SlGN PERNUT S���Y Fecilftiea 31 durnpster Ske Wwic Pertnft for dl new projects. Ail r.omme� re9�a�enb must maet cprnp4anco <br /> AttaCh f2) sets of Enpineered Plens. <br /> ""'PROPEk7Y SURVEY roQuired for all NEW conshuctlon. <br /> DlnctJons: <br /> F�u a,t �a�catia, comPls�ay. <br /> Ow�« 3 ConMactar aign back of ePWbetlon. notarized <br /> M tf owr 52600, a Notice of Commsnc�m�nt b requirod. (AIC upgndes ov�r f'75pp� <br /> AOant (for the canUedor) or Power of AttqneY (ror tha ovme� woW<i ba someons with nomrized iet� ir'am ewne� auq�orizin0 sa»e <br /> OVER THE COUkTER FERM�T iiNG (Front of qpai�� Only) <br /> Reroofa if shinpbs Sewers Savica UPGrades A/C Fence� (p1WS�ryq,/��� <br /> OrHeways-Not over Counter if on public raad�yayy..needs ROW <br />