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813-78D-0020 Gi��y o��'��pnyrn�ns �''C;CIf IIL H�J�JII�,auvi� • <br /> _ Building Dc�artm�n[ <br /> nhono Contacti'orPermitling "" ' <br /> Date Rec�ived � �"' "-"" ""- "'-� <br /> --- - -------- --i-i-i-�-Ni-rri-r-I-�-t-t-1-i-�9 --------- <br /> -I-t-h --- ------ -- - <br /> 1-Ii-Ii-hl-l-I-1-I-I-i-I-1- -�-- ----- • n � �Z <br /> Owner's Name E • Owner Phone m er v <br /> Owner Phone Num�er <br /> Owner's Address ' • � <br /> le Titiel�ofder Name Owner Phone NuniU�r� <br /> �ee Simp . . . • <br /> 1=�e Simple TiLleholder Address <br /> L. .. , ` LOT 9h � <br /> JO[3 ADDRGSS �� �� � . • <br /> SUI3DIVISION • ��r ��J ��L�s'�Z-- PA[�CGL[D1h ' <br /> {OBTAINED f-ROM PROPGRTY TAX NOTICG) <br /> SIGN [� MOV6 � DGMOLISI-I <br /> WORIt Pf{OP05CD ' NCW CONSTR � ADDIALT [� � <br /> � INSTALL . RCPAIR <br /> PROPOSCD USC' . �] S�R ' C� • COMM 0 OTI-IER <br /> TYPG Of CONSTRUCTIO[V � 13LOCK �� f-RAME � .0 STEEL 0 OTI-►ER <br /> DCSCRIPTION 01=WORK . . , <br /> CiU1LDING SIZC �_—� 5Q FOOTAGC I-ICIG(-I'f <br /> 13UILDING ��a, )/�/pI'S1 � d� VALUATION 01=T�TAL GONSTRUCTION . . <br /> /H 9'r�1' �I <br /> AMP SCRVICE [� I'ROGRGSS CNGRGY W.R.E.C. <br /> ELCCTRICAL :I� . . ' • • <br /> � 1'LUMRING 1G _ , <br /> 0 MCCI-IANICAL ,G VALUATION OF MCCI-IANICAL INSTALLATfON .� ( �� ( v <br /> 0 GAS 0 R001=1NG � SPCCIALTY [� OTI-IGR . . <br /> 1=L ZONC AREA �YCS [�]NO <br /> fINISI-IED PLOOR CLGVATIONS . ; <br /> ` COMPANY ��' "" � <br /> 13UILDCR r-cG cuaRer�T Y/N <br /> SIGNATURC R6GISTGftED Y! N . <br /> . . • . Licens��f� <br /> Address ' <br /> CLCCTRICIAN • COMPANY <br /> SIC�NATURC REGISTERG� Y/ N P6C CURRCNT Y!N <br /> , ' • Lic�nse�f � � <br /> Addres� <br /> PLUMI3CR • COIVIPANY <br /> SIGNAI'URC RCGISTERED Y/ N. f-GC CURRENT Y/N <br /> � License# C <br /> Address <br /> MCCI-IANICAL ' • ' COMPANY • <br /> 51GNATURC • - RCCISTert�� Y/ N �EE CURI�CNT Y/N <br /> ' .Licens��# <br /> Address • ' • <br /> OTI-IGR • � _ COMI'ANY � <br /> S1GNA'I'URC r��c�s7et�e� ' Y/ N f-CC CURRBNT Y/N <br /> � � License�t � <br /> Address ' � <br /> .12G51D�NTI,AL Attach(2)f'lot Plans;(2)sels oF 13uildinc�Plans;(1)sel'of En�rgy 1=orms;F2-O-W PermlLfor new conslruction, <br /> Minimum[en(10)wori<ing days after submiltal dale. Required onsifie,ConslrucLion Plans;Stormwaler Plans w/Silt�ence installed, <br /> Sanitary f=acillilos&1 clumpsi�er;Sifie Worlc Permit fior subdivisionsllarge p.rojecls <br /> CoMMGRGIAC Ailacli(3)complete sets of Buildinc►Plans plus a Life Safety Page;(1)sel of Cnerc�y Form S ormwai r Plans�w/Sill t=ence installod, <br /> Minimum len(10)worlcing days aftor submiltal dafie. Requirod ansite,Consfruction Plans, <br /> Sanilary 1=acilities&1 dumpsfier.Silo Worl<Permll�(or all new nrojects.All cornm�rcial requir�ments musl meel complfance <br /> ' SIGN PCRMIT Attach(2)seYs oi'Enc�ineered Plans.� • , <br /> ****PROPGRTY SURVCY r�quir�cl for all NEW consfiruction. <br /> -1-I-i-I-I-hFFhI-I-I-I-I-1-I-1-i-l-1-l-I-f-1-1-1-[-1-1-hf-I-hl-(-hl-I-hl-I-1-1-1-1-1-1-1-1-I-1-1-1-1-FI-1-I-1-I-hhI-I-I-1-f-1-l-1-l-I-I-1-I-I-1-I-I-1-1-I-1-1-1-I-I-I-1-I-1-1-1-1-I-I-I-I-I-I-1-I-1-1-1-I-(-1-I-1-I-1-1-1-1-I-1-1-1-1-i-I-I-I-Id-1-1-1-I-1-I-1-I-I-I-1-l-hl-l-1-I-I-1-h <br /> Dirocl:ions: . . , <br /> Pill out applicalion com[�letely. . , <br /> Owner&Contraclor sic�n bacic of application,notarizad <br /> If over�2500,a Notic�of Commencement is rec�uired. (A!C upgrades over:G5000) <br /> ** AyenL(for ihe conlrac[or)or Power of.4ttorn�y(�For th�owner)would b�someone with noYarized IEttcr�from owner auihorizing same <br /> OVGR Tl-iC COUNTCR PCRM1TTlNG (Pront of Appllcation OnlyJ <br /> RorooPs ' Sewers Sorvice Upgrados AlC f-enc�s(Ploi�lSurvey/�oofiage) <br /> Driv�ways-Nol over Counler if on puUlic roadways.:needs ROW <br />