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e�is-iou-uu�u c;�ry ot�ephymilis Permit Application Fax-613-780-0021 <br /> yy����7; Building Department <br /> �� <br /> Date Received -Z � phone Contaat for Pertnittin -_ <br /> OMrners IName Owner Phone Number �� ' � - <br /> Owner's Address � Owner Phone Number —� <br /> Fee Simple Titleholder Mame Owner Phone Number <br /> Fee Simple Tttleholder Address <br /> J08 ADDRESS l5,'� �.LJ� � � FL• � LOT#� <br /> SUBDIVI310N �, vQ(��U PARCEL ID# ' �' ' � ��I�— <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> lMORK PROPOSEO B NEW CONSTR� ADD/ALT Q SIGN Q Q DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SFR � COMM Q OTHER <br /> '1R�PE OF CON3TRUCTIOM Q BLOCK � FRAME � STEEL Q <br /> _ ,� <br /> �IESCRIPTION OF NVORK f' � <br /> BUILDIM(3 SIZE 3Q FOOTAGE ���� HEI(iHT <br /> BUILDING a ��1_ ' VALUATION OF TOTAL CONSTRUCTION <br /> l0 <br /> '�LECTRICAL $ ��� AMP SERVICE � Q PROGRESS ENERGY Q W.R.E.C. <br /> �Z3� � j��°"� <br /> "�`PLUMBING a 5��� � S„���v¢., / f),js2� � ��.� <br /> S�q'�.° �.� / <br /> Cf�' �� <br /> �QAECHANICAL a �j� VALUAT10N OF MECHANICAL INSTALLATION � N � CfJj� ���e <br /> 3 �'� �- <br /> QGAS � ROOFING Q SPECIALTY Q OTHER i.�' �r��s <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO�� ��(SG4� <br /> BUILDER � � COMPANY ^ <br /> SIGMATURE 1-�-" pw''�., REGISTERED Y/ N FEE CURR Y/N <br /> Address �(1�Xx�! '(� � � � 3 License# �� • Z I��Y <br /> ELECTRICIAM � � COMPANY <br /> SIGNATURE �� � REGISTERED Y/ N FEE CURRE� Y/N <br /> Address �"-t� � License# C l.�/V v�c��"1 � <br /> . � <br /> PLUIbIBER i YI COMPANY <br /> SIGMATURE �'�`^�� V.�`� REGISTERED Y/ N FEE CURRE� Y/N <br /> Address �� lu�v License# F� Fl <br /> M�CHANICAL '' � `l ,�^ COMPANY �C � � � � <br /> SIGNATURE V'�^^- REGISTERED Y/ N �e rten Y/N �� <br /> Address l,�, � 3 License# li <br /> OTHER �' � �- �`'� COMPANY I � I <br /> SIGNATURE �tN�-" REGI3TERED Y/ N FEE CUR Y/N _ �_ <br /> ,Addreaa 't� � . i'1U.1 "1 Q- � Ltcense# r�-L�..V:J�� � � <br /> RESiDENT1AL Attach(2)Plot Plans;(2)seb of Building Plans;(1)set of Energy FoRns;R-O-W Permit tor new construction, <br /> Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Pians w/Siit Fence instatied, <br /> Sanitary Faciilties d�1 dumpster;Stte Work Permit for subdivislons/large proJects <br /> COMMERCIAL Attach(3)complete sets of Bullding Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction. <br /> Minimum ten(10)worlcing days after submfttal date. Requlred onsite,Conshuction Pla�s,Stormwater Plans w!Silt Fence installed, <br /> Sanitary Facilities 8 1 dumpstet.Site Work Permit for all new proJects.All commercial requirements must meet compliance <br /> SIGM PERMIT Attach(2)sets of Engineered Pians. <br /> ••"'PROPERTY SURVEY required for all NEW consUuctlon. <br /> Directions: <br /> Fill out application compietely. <br /> Owner&Contractor sign back of applicatlon,nota�ized <br /> If over 52500,a Notice of Commencement la required. (A/C upgrades over=7500) <br /> •• Agent(for the contractor)or Power of Attomey(for the owner)would be someone wtth notarized letter from owner authorizing same <br /> OVER THE COUNTER PERMITTING (Front of ApplicaUon Only) <br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage) <br /> Drivevray�-Not over Counter if on public roadways..needs ROW <br />