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o��-�m,-���� v��y �� c.cN��y������� � ������.,--.r���..�..�..�� <br /> Buflding Departrnent <br /> 1'�oNi�� <br /> Date Rsceived " � Phone or�tact for Pe Ittin � ( 3 Z 6`t � (p S <br /> Owner's Name �G��G IJ l�1�.,.°.� Owner Phone Number <br /> Owner's Address � j � 1 S"i- Owner Phone Number � � <br /> Fee 8lmple Titleholdsr Name Ownar Phons Number �- � <br /> Fee Simple Titleholder address <br /> JOB AIaDR�33 �J�( ST ZC�PA ft��1/S �L �S "� �'y � LOti� 5 '�' � <br /> SUB[�IN.I,$I�N ��'1Y o� Le F'�p:y h�t� S PARCEL ID# � i �.��-:Ll - CZ G� p- ..I'1 O� ° C.`��S <br /> (OBTAINEb FROM PR�PEkTY TAX NOTI6E) <br /> WORI4;PRQAO$ED NEW CONS7R AQD/ALT [� SIGN Q Q DEMOLISW <br /> INStALL 8 F7EPAIR <br /> PRORASED.USE [� SFR � COMM [� OTHER <br /> TYPE OF CON8TRUC7]ON Q BLOCK Q FRAME Q STEEL Q <br /> DE8CRIRTK,IN OF WORK ��STI�t I �' y ` ',,J � ,,V � ��� O� � f,j•�.� <br /> BUILDIN(i SIZE SQ FOOTA(iE� HEI(iH7 . � ��� � �, ��t k <br /> ��aTe s <br /> QBUILDINC3 S [y� ' �` �� VALUATION OF TOTAL CONSTRUCTION <br /> T <br /> [�ELEC7RICAL a AMP SERVICE Q PROC3RESS ENERGY Q W.R.E.C. <br /> QPLUMBINO a <br /> QMECHANICAL a VALUATION OF MECMANICAL INSTALLATION <br /> QGAS Q ROOFING Q SPECIALTY � OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO <br /> G ��� � <br /> BUILDER OMPANY I.Ow-8S No.»�, CeN��2� �oJ[. <br /> 81GNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address o �o� $ Q 3 �T A�c d� �z S 78� License# L 6 S O 1 <br /> ELECTRICUIN COMPANY <br /> 81GNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# � <br /> PLUMBER � COMPANY <br /> SIONATURE RE(31STERED Y/ N FEE CURRE� Y/N <br /> Addroas Ucense# � <br /> MECHANICAL � COMPANY <br /> 31�3NATURE REGISTEREO Y/ FEE CURRE� Y/N <br /> Addresa License# � <br /> OTHER � COMPANY <br /> SIONATl1RE REt31STEREp Y! N FEE CURRE� Y/N <br /> Address L(cense# � -� <br /> RESIDENTIAL Attach(2)Plot Plans;(2)aets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construcdon, <br /> Minimum ten(10)wo�lcing days after submittal date. Required onsite,Constructlon Plans,Stormwater Pians w/Silt Fence Instailed, <br /> Sanitary Fadlitles&1 dumpster,Site Work Permit for subdivlsfons/large pro)ects <br /> COMMERCIAL Attac��(3)complete sets af Buliding Pl�ns ptus a L'fe Safet�?�gs;(1?ss!of Etser�y Fcr,res.P.-O-V4'Permlt for��ew w�atructio�+. <br /> Minimum ten(10)work(ng days after submittal date, Required onsite,Construction Plans,StoRnwater Plans w/Silt Fence installed, <br /> Sanftary Fadfldes 81 dumpster.Site Work Pertnit for all new projects.All commercial requirements must meet compllance <br /> SI(iN PERMIT Attach(2)sets of Englneered Plans. <br /> """PROPERTY SURVEY required for all NEW constructlon. <br /> Directlons: <br /> Fill out applicatfon completely. <br /> Owner&Contractor sign back of appllcaUon,notaAzed <br /> If over s2s00,a Noti¢e of CommencemeM is required. (AIC upgrades over:7S00) <br /> " Agent(for the contractory or Power of Attomey(for the owner)would be someone with nota�ized letter from owner autho�izing same <br /> OVER THE COUNTER PERMITTING (Front of ApplicaUon Only) <br /> Reroofs if shfngles Se�wers SeMce Upgrades A/C Fences(PIoUSurvey/Footage) <br /> Drlveways-Not over Counter if on pubiic roadways..needa ROW <br />