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From 12/12/2012 15 54 #122 P.002/003 <br /> .••,,-•--•,-�- vu y v��cyn y��un a r o�n u i�yNm.a uvn o^-��—•••w��• <br /> Builtling Oeparbnent <br /> Osta Ruol�ed Phone Contact fir Permkllny <br /> oN,��r�N�� _ ���Y �wna Phons Number d�� 5 7.J�O <br /> Ownor's Address O�wner P�ona N�mMr <br /> Fee Simpk THNhold�r Nama � Omxr Phons Number <br /> Faa Sl�npla Titl�holtl�r Addrssa <br /> JOB AD�RE86 � W �' L� V l�if' � r7 e Z� h� r /�� LOT i1 � <br /> susarvisioN I o7t �-/✓� �� QC12. P,nr�c�wa 35 J~- /-CX�J�O-�GUOD-USjG <br /> (OBTAINEd FROY PROPH[fY TAX NOTICE) <br /> WORKPROPp$EO e NEWWNSIAB ADD/ALT C� SIGN Q Q DEMOLJSH <br /> INSTALL REPAIR <br /> PROPOSEDl15E Q SFR Q COMM 0 OTHER <br /> TYPE OF CONSTRUCTION Q BIOCK Q FRAME � STEEL Q <br /> DESCRIPTION OF WOR1S L�Iti(O V�. � G./e5 i�.s / J�d-^ L�//�)2�75iU�'7� <br /> BUILDING SIZE SQ FOOTAtiE �GG MEiaHT � <br /> BUILDlNG S �Oy� VALUATION OF TOTAL CONSTRUCTION <br /> QELECTR�CAL S AMP SEitViCE Q PR06RESS E�ROY Q W.R.E.C. <br /> OPLUMBINO S <br /> QMECHAN[CAL S VALUATION OF MECHANICAL iNSTAUATION <br /> QOAS ROOFING Q 3PECIALTY Q OTHER <br /> FINlSHED FLOOF2 ELEVATIONS � FLOOD ZONE AREA QYES NO <br /> BU�DER COi1PANY � <br /> 81GNATURE q6pshr�n Y/N FEe cuwtEn Y/N <br /> Addross Lfceme• <br /> £LECTRIGAN � COYPANY <br /> SIGNA7VRE L qE��sie� Y/N FEE CURNEM1 V/N <br /> Addnsc Lkenselt� <br /> PLUMBER COYPANY <br /> S7GNAT1lRE �� aECisrert�n V/N s�E ax�+. Y/N <br /> Addnu License# � <br /> MECHANtCAL CONPANY <br /> SIGNA7URE r�ctsreneo Y/N �c�nREr. Y!N <br /> Addroas Ueense# <br /> OTHER / / O,DY� F//UGl 4 v�-"����3 �/�}C� - <br /> SIGNATURE nEGisTEam Y/N �e cuas�r. Y!N <br /> A�e►... / 9 .3 o�o.sassa.- 2�✓• �vv ��3,�5�� u�e� CCC/3d 59 9 3 <br /> RE8WENTIAL ACad�(2)Plot Plans;(2}sets M 9uA�Plans;{7)xi ot Er�gy Forms;R-O-W Permlt for new ca+strucEon. <br /> l�Ahircrium letf(10)v.dking Aays attar submitlal dah. Reqdred onslte.ConstrucUon Piare.SWrtnwater Plans wl SNt Fence Msta9ed, <br /> SanlUry Fsdqllea 8 1 dumpstar;SI1a Wpk Parmk for subdvidorollarge pro�acls <br /> COMMERCUIL AttacA{3)aanptete eets of BWldlnp ptana piue a Lifo Safey Page:(t)set of Enargy Fama.R-0-W Parmk for new eorsstrucUOn. <br /> MMYmum ten(10)woikkfp tlays afler submlt�date. Requhed onslte,ConstrutUon Plane.Stamwalar Plans w!Sik Fence insW Il�ad. <br /> SaNtery FadBtles 6 9 0umpatsr.Site Wnric Peemit tor�I new proJects.Atl oommerdal requirements must meet campUence <br /> SIGN PERMIT Attach(2)sets of Enqineered Plans. <br /> ""PROPERTY SURVEY roqutred for all f�W oonshucflon. <br /> Diroetlona: <br /> FNI out apptlt�dan ten+pletey. <br /> Ovmer 8 Contractor aign baek of apphcatlon.nomrizeo <br /> If over 52300,e Notiu M Comm�nument is nqutred. (A!C uppndes over=7300) <br /> ° AB�t(!or fhe coMnctar)w Powar of Aleomey(for tl�e awrcar)wnWd be someone wfth rmtarizetl letler hom owna a�Morfzing same <br /> OVER THE COUNTER PERMITTINfi (Fmnt ot Applwtion ONy) <br /> Rxoots i!shtnglas Sewers Servka Upgrodes A/C Fences(PbV3txvey/Foofage) <br /> Driwways-Nol over Counter H on puWk roadways..neatls ROW <br />