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cs�is-iesu-uuzu �,1[y o� LttNny�inn� rrsiini�r�NNni.au��� ._.._._ .-- ---- <br /> Buiiding Departrnent <br /> Date Received �� Phons ontact tar Pe ItNn � 3 - �('6 S <br /> Owners Name 'Z Owner Phone Numbsr - ,Z.p <br /> Owner's Address J � /� /L� Owner Phone Number <br /> Fss 8imple Titleholdsr Name Owner Phons Numbsr � <br /> Fee Simple Titleholde�Address <br /> JOB AI�DRE38 3 (O �Z Ah/t h i � � L07� �-1 <br /> 8UB[�la/�$10�1 z P�� R �'1 "r 5 PARCEL ID# � - � 21 - 3 °- O I - C9� 6 <br /> �osrNNeu�rtoM�reoPem r�►x Non¢e� <br /> WORlC:PRf�08fD NEW CONSTR AqD/ALT Q SI(3N [] [� DEMOLISW <br /> INSTALL 8 aEPAIR <br /> PROR08ED.U3E [� SFR � COMM � OTHER <br /> TYPE OF CON81'RUCTIt)N Q BIOCK Q FRAME L� STEEL Q <br /> DESCWPTKJN OF WORK gPl �` S t CJ � p , <br /> ��'S Si S�Z <br /> BUILDINO 81ZE 8Q FOOTA(iE� HEI(iHT <br /> . UILDING S q VALUATION OF TOTAL CONSTRUCTION <br /> ( <br /> QELECTRICAL s AMP SERVICE Q PROCiRESS E Y Q W.R.E.C. - <br /> OPLUMBIN(3 � � � � <br /> J 5� <br /> QMECHANICAL � VALUATION OF MECHANICAL INSTA TION,�/ � <br /> l <br /> QGAS Q ROOFING Q SPECIALTY [� OTHER —`� <br /> FINISHED FLOOR ELEVATIONS FLOOD�NE AREA QYES NO <br /> ' � �.�a 1�� <br /> BUILDER COMPANY L Ow�t S<l�G.» C g,aTtlZS '�/�., <br /> 31(iNATURE REGISTERED Y/ N Fee CuR�P Y/N <br /> Address o �o� � 43 Rl'A�d� �zg7�' Lfcense# G6G ( Sc7F�171 <br /> ELECTRICWN COMPANY <br /> 81GNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> PLUMBER COMPANY <br /> $����� REOISTERED Y/ N FEE CURRE� Y/N <br /> Addresa Llcense# �— <br /> MECHANICAL COMPANY <br /> s�a��� REGI3TERED Y/ N FEE CURRE� Y/N <br /> Addross Ucense# l � <br /> OTHER � COMPANY <br /> SKiNA7URE REOISTERED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> RE8IDENTIAL Attach(2)Plot Plans;(2)sets of Building i�lans;(1)set of Energy Forms;R-0-W Permit for new constructlon, <br /> Minimum ten(10)working days after subnhittal date. Requlred onsite,Constructlon Plans,Stortnwater Plans w/Silt Fence installed, <br /> Sanitary Fadlities&1 dumpster,Site Wor�c Permit for subdivlsionsltarge projects <br /> COMMERCUIL Attach(3)complete sets of Building Plans'plus a Ufe Safety Page;(1)sot of Energy Forms.R-O-W Pemili for new qnstrucdon. <br /> Minimum ten(10)wvrking days after subrmittal date. Required onsite,Construction Plans,Stormwater Plans w/Sift Fence installed, <br /> Sanitary Fadlitles 81 dumpster.Site Work Pennit for all new projects.All commerclal requirements must meet compliance <br /> 81CiN PERMIT Attech(2)sets of Engineered Plans. <br /> '"'•PROPERTY SURVEY required for all NEW constructlon. <br /> Dlrections: <br /> Fiil out appNcaUon completely. <br /> Owner S Contractor sfgn back of applicatlon,notarized <br /> If over:2s00,a Notics oi Commencement is roquired. (AIC upgrades over;TS00) <br /> " Agent(for the contractor)or Power of Attomey(f+or the owner)would be someone with notarized letter from owner autho�izing same <br /> OVER THE COUNTER P�RMITTINl3 (Front of Appl(catlon Only) <br /> Reroois H shingles Sewers Servfce Upgrades A/C Fences(PIoUSurvey/Footage) <br /> Driveways-Not over Counter if on public roadways..needs ROW <br />