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Date Received <br /> Phone Conhet for P�rmlN�n �SZ- G��c,/ <br /> - 4��lo�. <br /> owners Name `� ��, � �,�C� �..2 7.3/ <br /> Owner Phone Number �� - ��Z - L��,� <br /> Owner'sAddress �p�/ ,'r� �� - � 3,nJ <br /> ' �� � Owner Phone Number <br /> Fee Simple Titleholder Name 1 � ��� a731 � <br /> Owner Phone Number <br /> � i Fee Slmple Tftleholder Addross � b,5� �'�.G _ `1 r !11 1 �3�CI� <br /> Y <br /> �,1 I JOB ADDRESS -�,� �i,��� �.j 2� �. ` �.\I f�1 3�s�� � <br /> 1 LOT N <br /> /�, SUBDIVISION <br /> � ' �' 1 PARCEL IDA� <br /> h � � � <br /> �.�1 ^�� WORK PROPOSED B (OSTAINED FROM PROPERTy TAX NOnCE) <br /> NEW CONSTR� ADD/ALT C� SIGN Q <br /> � INSTALL REPAIR Q DEMOIISH <br /> /� PROPOSED USE Q SFR � COMM <br /> 'I �if' TYPE OF CONSTRUCT�ON [� BLOCK O OTHER <br /> Q FRAME C� STEEL Q <br /> DESCRIPTION pp yypRK �, �j , ��.� <br /> BUILDING SIZE �X Z�� gq pppTAOE� <br /> HEI(iHT <br /> QBUILDING Z <br /> 3�j(���� VALUATION OF TOTAL CONSTRUCTION <br /> QELECTRICAL S AMP SERVICE �• �Q ��$ <br /> QPLUMBING s �MITfE� t'LH1V�S�tl�Y�S��Yp�:' �.E.C. <br /> �Y YR LI.S�IRE h�ARSHAI.'S OFFI�," <br /> QMECHANIC/LL. �a � C• 3 <br /> s VALUAT10qt� I L T U► � � <br /> .�i.dV:QVI"C!: � <br /> QGAS Q ROOFING Q SPECIALTY � OTHER <br /> FINISHED FLOOR ELEVATIONS <br /> FLOOD ZONE AREA QYES NO <br /> BUILDER <br /> SIGNATURE Z Q �� `\,�,\� �t' K� �73� ��MPANY <br /> REGISTERED Y/ N FEE CURRE� <br /> Add►eas ��.5 (f/i f e Rt,� 7 � Y/N <br /> � —eP � , �} 3�s� u�,se� <br /> ELECTRICIAN <br /> SIGNATURE COMPANY <br /> REGISTERED Y/ N FEE CURREI. Y/nJ <br /> Addrose <br /> License# <br /> PLUMBER <br /> SIGNATURE COMPANy <br /> REGISTERED Y/ N FEE CURRE� Y/N <br /> Address <br /> � Ltcensa!J <br /> MECHANICAL <br /> SIGNATURE COMPANY <br /> REGISTERED Y! N FEE CURRE� y/N <br /> Addross <br /> �icense� � <br /> OTHER <br /> SIGNATURE CONPANY <br /> REGISTERED Y/ N FEE CURRE� Y/N <br /> Addrosa <br /> License# <br /> RESIDENTIAL Attaeh(2)Plot Plans;(2)sets of Building Plans:(1)set oi Energy Fortns;R-O-W Pertnit for new construction, <br /> Mln�mum ten(10)wwking days after submittal date. ReqWred onsite,Constructlo�pla�s,Stortnwater Plans w/Silt Fence installed, <br /> Sanitary Fadlltles 8 1 dumpster;Site Work Permit for subdiWsionsNa►ge projecfs <br /> COMMERCIAL Attach(3)complete aets of Buildkig p►ans plus a Life Safety page;(1)set of Ene�gy Forms,R-O-W Permit Tor new consWctlon. <br /> Minimum ten(70)working daya after aubmlttal date. Requlrod cnslte,Conskucfton p�ans,Stortnwater Plans w/Silt Fe�ce insfalled, <br /> Sanitary Fadlides 3 1 Oumpeter.Site Work Pertn{t for all new projects.,qp commerdal requirements must meet compliance <br /> SIGN PERMR Attach(2)sets of Erglneered Plans, <br /> ""PROPERTY SURVEY requlred for all NEW constructlon. <br /> Dlroetions: <br /> Fill out applicaUon completely. <br /> Owner 3 Contracyw sig�pack of applicatlon,notarizad <br /> If over=2500,a NoNce ot Comm�ne�ment Is rsqulnd. (A/C uppndas ow►f7S00) <br /> " Agent(for fhe confractor)or Power of Attomey(tor the owner)would be someone wilh notarized letter hom owner aufhorizing same <br /> OVER THE COUNTER PERMITTING (Front of Applicatlon Only) <br /> Reroofs i(shingles Sewers SeMce Upgredes A/C Fences(ploVSurvey/Footage) <br /> Driveways-Not over Counter if on puDlic roadways..needs ROW <br />