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s�3-�aaoo2o Ci of Ze h <br /> t?' p yrhi!(s Permit Appiication Fax-81378a-0621 <br /> BuNding pepartment <br /> Bate Received <br /> Phorn CoMact for Pertnftting <br /> Owner's ldame �_ �D �� �D� <br /> Owner Phone Mumyar <br /> Owncr's Address C �j/n�j�� f�Q� _ — <br /> J -o�ybr �f d <br /> Fee Simpic Titieholder Name Q►� {��C'� ���Z L.[e (—j—/ � � �� ���� //� <br /> Owoer Phon�Num6er [ (�//' <br /> Fet Sitnpte Tfileholder Addrcss ' Z� O N S I�n�E �(1� � 3,�c;� �r,� wtd n A j 'l ' Q:.-f <br /> JOB ADdRESS Q� �L L L.� � �Q/{/� r <br /> l0T# � <br /> SUB�NISIQN PARCEL 1D/ �J' � 'Z I "-UC7 I C•-C)� �� �C��Q <br /> 1NORK PRG1P65ED e � IoeT�M�rROM pqp��Ty t�x No�� <br /> NEWCONSTRB ApDlALT SiGN � [� DEMOUSH <br /> ft�iSTALI REPA�R <br /> PROPQSEQ USE Q SFR � COMM � OTHER <br /> TYPE OF CONSTRUCTION � 9LOCK Q FRAME � STEE� O <br /> DESCE�IPTfON OF WQRK � ���' � N��CGt � � <br /> � � "t�1 •�v�U'�e.( '7'C3 rv;v,�z.� <br /> BUILDtNG StZE � - r SQ FOOTAGE �Y �t S S <br /> HE{GHT <br /> �BUlLDING y - <br /> VALUATION OF TOTAL CONSTRUCTION <br /> �LECTRICA� �� 0.MP SERVICE O PROGRESS ENERGY <br /> a W.R.E.0 <br /> �PLUMBtNG �� <br /> �MECHANICAL s VALUATIQN OF MECHANICAL tNSTALLATION <br /> �GAS Q ROpFING Q SPECIALTY � OTHER <br /> F(Nt$HEO FLOOR E�EVATIONS �� FLOOD ZONE AREA �YES Np <br /> � <br /> BUILDER � PANV ���( ��N�jYI,UGr�r.1 l`3 Q. <br /> SIGNATURE nEGrSr�pED Y/ N Fff CURREA y�N <br /> Address ' O� }'l� �"l � � 'C�A�� F'C ,S-�•S�UJ v �, <br /> I � - ucense# r V-� ��cs ►�'iU4 <br /> � ElECS'hlCiAN �� COMPA►�tY L L EL�L� I�' <br /> SICsMATURE <br /> �r 4,'+��6 � R[��srenEO Y/N FEE CURREA Y 1 N <br /> �' y�: � Address L'9,� '— <br /> ��-1 �'3 e ' /2o c.�•�,a F� u�6e x �L' >#/'3C-�fa / d�, <br /> PLUMBER COMPAHY �� U��'��,�,��'. <br /> S(GNATUR£ � nEGisieteEO � Y/N pEe�, Y!N <br /> �a�ess y 3 a �,�►s .9 v� �cs g' .r-L ��,�� C'Fe d sG Q� � <br /> MECliAMlCAL �r• M�X CQMPANY .�'*r� I' YT�,,{� <br /> SlGNATttRE '� � � � REGISIEREV Y!N frtecuRrtEn Y!N � <br /> Address � V� L �� �� j}��SS,A FC <br /> Ucense i1 <br /> a��R � CQMPANY <br /> SiGNATURE nEG�St�o Y/ N r'EE tUr�n Y/M <br /> Address � <br /> Lioense# <br /> RESIDENTIAL Attadi(2j P(at Plans;(2)seta pf 9ulkfing Plans:(1}sel of Energy Fom�;R-O-W Pertnit tor new corssWction. <br /> Ml�hnum 1en(10)wohcing days aRer s�m{Gal date. Required orulte,Constnledon Plar�s,Stortnwater Plans wl Silt F�ce installed, <br /> Sanitary Fedlities 6 1 dtm�pste�;S�te Waic Pertnit Tor suhdWislonstlarge proJeds <br /> COMMERCIAL Attach{3)complete sets of BuUdng Ptans plus a LKe SaTely Page;(9)aet nf Energy FWms.R-O-W Permit for new cona(ruc(lon, <br /> Minimum Ien(10J work"vtg days aRer s�rnHtal date. ReqWred onstte,Constructron Plans,Stormwater Plarts wl Sflt Fence Insfalled, <br /> SaMtary FadDtles 3 1 dumpst�.Slte Wwk Permlt tor all new projecls,All commerGal reqWrements must meet compliance <br /> SI6N FEttMR Altach(2)sets of Enqlrx�ed P�ans. <br /> ""PROPERTY SURVEY reqtdred for all NEW consWcfion, <br /> OlrecNans. <br /> Ffil out appNcatlon campletely <br /> Owner 3 Conlractor sign back of appfiqUan,notarized <br /> 1(over t2500,a Notice oi Commencement is roqufred. (/UC upgradea over 57506) <br /> " Age�t(b�the canVactor}or Power of Attomey(tor 6ie own�}vwutd be someone with notar¢ed letter hom owner auMwrtzing same <br /> OVER THE COUNTER PERMITTIMG {Front ot ApplfpUon Oniy) "— <br /> Reroots if shingles Sewers Service Upgrades A/C Fences(PbVSurveylFootage) <br /> Drtveways-Nat over Counter if on public roadways„needs ROW <br />