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o��-►ov-w�v v��y v� c.cN��r���n�� � ������.�.rr��.....,..�� <br /> � ' Buildtng Department <br /> /'^ � N i;., a <br /> Date Received• . - Phone¢oMact tor Pe�nittin �! 7j Z 6 1 - -�'��l (v s <br /> � <br /> Owners Name � � � t � Owner Phone Number <br /> Owner's Address �� 1� T� s�T Owner Phone Number I <br /> Fae 8lmpis Titleholdsr Name � Owner Phone Numbsr � � <br /> Fee 8imple Tkleholder Address <br /> JOB ApDR�33 �D �1t7 '1 Th S� Z k� � s � i 3 3 5�z �oT� Z�-2 S-�� <br /> SUBqNl1,810N i 7` at' Z<'.P�ti ��l/S PARCEL ID# � � ' Z-� " 2 J-Ota i� - 21�#1t c7 - C�Y.7G <br /> (08TAINED FROM PROPERTY TAX NOTIaE) <br /> WORI�;PROP0,8ED NEW CONSTR AqD/ALT Q SIGN Q [� DEMOLISW <br /> INSTALL 8 REPAtR <br /> PRORU$ED USE Q SFR � COMM � OTHER <br /> TYPE OF CON8TRUCTInN Q BLOCK Q FRAME STEEL Q <br /> DESCRIPTION OF VYORK C� C���� <br /> BUILDINO 81ZE ---�- ---- _ 8 OTA�3E� HEIf3HT <br /> BUI ING S � ' � <br /> � LUATION OF TOTAL CONSTRUCT N � � 5� <br /> [�ELECT � / a AMP SERVICE Q RGY W.R.E.C. <br /> QPLUMBIN(3 � � t��j�� <br /> ----- `� l�`C <br /> MECHANICAL a VALUATION OF MECHANICAL INSTALLATION �� <br /> __�� <br /> Q ROOFING Q SPECIALTY Q OTHER <br /> F�NISHED FLOOR ELEVATIONS FL006 ZONE AREA QYES NO <br /> G ��d �� <br /> BUILDER COMPANY L ow�cS No.„t �eN`��2s ��l c. <br /> SIGNATURE REGISTERED Y/ N FEE CURRE►� Y/N <br /> Address O �O k O ��✓ ��A�d° �i"$�`� License# �C.r�o�, ( .S O �t7�-� <br /> ELECTRICWN COMPANY <br /> 81GNATURE REC3ISTERED Y/ N FEE CURRE� Y/N <br /> Address License# � <br /> PLUMBER COMPANY <br /> 810NA7URE REGISTERED Y/ N FEE CURREP Y/N <br /> Address License# � <br /> MECHANICAL � � COMPANY <br /> SIONAIURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# � <br /> OTHER COMPANY <br /> SIONATURE REGISTERED Y/ N FEE GURRE� Y/N <br /> /lddress L(cense# � � <br /> RESID�NTWL Attach(2)Plot Plana;(2)seta of Buildtng Plans;(1)aet of E�ergy Fortns;R-O-W Pertnit tor new oonstructlon, <br /> Minimam ten(10)warking days after submittai date. Requfred onsite,Constructlon Plans,Stormwat�Pians w/Silt Fence installed, <br /> Sanitary:Fadlitles 81 dumpater;Slte Work Permit for subdivisionsllarge projects <br /> COMMERCIAL Attach(3)camplete sets ai�ultdir�g Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permft for new construcdon. <br /> Minimwm ten(10)worlcing days after submittal date. Required onsite,Const�uctlon Plans,Sto►mwater Plans w/Silt Fe�rce Instaileo, <br /> Sanitary Fadfltles 81 dumpster.Site Work Pertnit for all new pro)ects.All commercial requfrements must meet compliance <br /> 31CiN PERMIT Attach(2)sets of Engineered Plans. <br /> """PRbPERTY SURVEY required for ali NEW constructlon. <br /> Directions: <br /> Fill out appllcatlon completely. <br /> Owner&Contractor stgn back of applicatlon,notarized <br /> lf over s2500,a Notl�e of Commencement is requlred. (NC upgradea over;7S00) <br /> '• Agent(for the contraator)or Power of Attomey(for the owner)would be someone with notarized letter from owner autho�izing same <br /> OVER THE COUNTER P�RMITTIN6 (Front of Applicatlon Only) <br /> Reroots if sh(ngles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage) <br /> Drlveways-Not over Counter if on public roadways..needs ROW <br />