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, aiaaso-oo2o Ci of Ze h <br /> tY p yrhills Permit Application Fax����s�i <br /> auilaing Dep�*n+em <br /> Dne Reeeived <br /> �-,-, w+�,,.co�d ro.w�m� So1 `]A Gi- '` <br /> o�,ers N,� 1111�� - Jv ( <br /> ow�,�w,��N�� �1 <br /> ow�ers aea.�� � Z.S�U' � r j,�- • <br /> Oirner Phone Nunher <br /> Fee Simple Titlehdder Name <br /> Owner Phone N� <br /> Fee Simple TiMehdder Address <br /> JOB ADDRESS � +r P ` <br /> �' � LOT� �� <br /> S�BO��oN W-e d �E��� tD- 2c� -2 f -O -c�0000--0 <br /> WORK PROPOSED (aBTANED FRaY MtOrBZiY TAY NOTICE) <br /> � NEwcONSiRe ADDlALT � S1GN � Q DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE SFR Q COMM �� <br /> OTHER <br /> TYPE OF CONSTRUC710N Q gLOCK FRAME <br /> �� STEEL � <br /> DESCRIPTION OF WpRK �� ( �� <br /> I � <br /> BWLDING SRE SQ FOpTAGE ��Q� � <br /> HqaHT <br /> QBUILDING (;�� <br /> L VALUATION pF TOTA�CONSTRUCTION <br /> QELECTRICAL $ AMP SERVICE <br /> Q PROGRESS ENERGY Q W.R.E.C. <br /> OPLUMBING a <br /> QMECHANICAL � VALUATION OF MECHANICAL IN$T,qt,LpTION � q ( 1 <br /> 0� Q ROOFING SPECIALTY � <br /> � OTHER <br /> FINISHED FLOOR ELEVATIONS F�Op�ZONE AREA <br /> QYES NO <br /> BUILDER CO�IPANY � <br /> S16NATURE <br /> r�s�r�n Y/ N �E cura�n y!N <br /> Address <br /> License# <br /> ELECTR�Cl/W <br /> SIGNATURE �P�' <br /> ���o Y/ N �cuw�n Y/N <br /> Address � <br /> License#�--- <br /> PLUYBER <br /> SIGNATLRE C�NPAMY <br /> �c,�s'rE�n Y/ N FEE cuRtt�n Y/N <br /> Address � <br /> License# �— <br /> MECHMpG/1L <br /> SIGNATURE �Pµ1' <br /> _ rx�c,�s�r�o Y/ N rEe cuw�n Y/N <br /> Address <br /> License# —� <br /> OTHER � <br /> 51GNATURE - C�PN'�Y .�S <br /> �c,�srEtt�� Y N r-�c�, Y N <br /> Address � CQI/�.J License it Il.� � <br /> 111111111111 � 1111 � 111111111111111111 / 111111 � 11 � � 11111 / 1111111111111 <br /> RESIDENiIAL Attach(2)°bt Plane:(2)sets of BtA7ding Plans:(1)set of Ener9Y Forms�R-o-W Permit for new construdim, <br /> Minimum ten(10)working tlays arypi submittal dale. Requved onsi[e.Cons[nictfon Pl�s,S[amwieter Plens w!Sit Fence installed, <br /> Sarrtary Faci66es&1 dumps�er,Site Worlc Pdmit for su <br /> GOMMERCIAL Attacry(g)c�p�e sets of g� p�� ��Q�� <br /> Minimum[en 10 �9 P�a life Safery Page;(�)set of Energy Farms.R-O-W Permit for newconsWction. <br /> ( )��^9 days aftersubrrdttal date. Required onsi[e�Constniction Plans,Stamwater Plans w15ik Fence insWlled, <br /> Sanitary Facilities&1 dumpstec Site Work Permit frn aB new Projeqs.qr commga����y�m�meet c�p�� <br /> SIGN PERy�T Attach(2)sets of Engineered p4jn� <br /> ""PROF'ERTV SURVEY reqiired(a ay NEW co�tructio�_ <br /> DireGipK_ <br /> Fi1 out applicatiqi compl�t�y. <br /> Owner&ConOacta sign back of appp�p�.n�� <br /> H over 52500,a Nalce W Cq�ma�canent is�equited. (AIC W�Bradea over S7S00) <br /> •• qge.nt(for the contractar)or Power of Attomay(fa the owner)nquld pe snm�e y��arized tetler{rom���a�gyme <br /> OVER THE COUNTER pERNfT1yrG (Front d qpplit�t�n p�y� <br /> RerooFs if shingles Sewers Service Up4Aades A/C Fences(PbVSurvey/Footage) <br /> DNveways-Not over Counter if on puWic rp�dwayy..needs ROW <br />