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� � <br /> �1�78D-002D i <br /> � City of:?ephyfiills Permit Applicati�n z ^��a:B�3� ocri <br /> � r Bu�ding Depadmant ��,���Q �'J�J �f3��- <br /> OrYn d ��" �� Dhon�ConqCt tor P�rmiltkw ""� -! - (!C <br /> � ■ � � 1 1 1 1 1 �7 1 <br /> �°� "^� � r� QwnerPFwneNu�n6er �J 7 � <br /> � �—� <br /> Ovm�rs Q►!ss 1t�Ow�rphone Humber <br /> F°°�� °�°���� � p Owner Phon�Numb�r <br /> --I <br /> Fes S •TltNhoider Mdeeaa <br /> J08 AD 68 � �/' <br /> LOTN <br /> SUnDN !ON . PARCEL m1t d"'�'0111 ��1 'v[.8[� • ��' O <br /> (oer.�a��Fator nwooatn rivc aoncq <br /> WORlC PQSED � NEW CONS�R ADO/ALT SIGM ' <br /> INSTALL e ' REPAIR � � O �MOi.I � <br /> PROPCB D[13E Q SFR Q COMAA Q OTHER <br /> TYPE OF ONSTRi/CTIpN Q BLOCK Q FRAME � STEEL Q <br /> OESCRI ON OF WORK �� � � j k ,�_�G(,�,k j'y�*>�� <br /> BtriLCt SRE Sf?FOOTAC#�� �� ' <br /> i <br /> U[LDING S VALUATION OF TOTAL CONSTRUCTIOfJ <br /> J� <br /> �ECT�� $ AMP SERViCE Q PROGRESS ENER(iY �] � .R.E.�. <br /> i <br /> LUA�MG $ <br /> ANICAL $ VALUATION OF Iu�CHANiCAL IfiSTALLATION ��� ' � . <br /> i <br /> � Q ROOPING Q SPECIAITY Q O7HER �' <br /> FUJISH FIODRELEVATIONS FLUODZOAIEAREA �VES NO <br /> �� � ���� <br /> � ��� � <br /> BUIIDER � �' COMP/WY � .� �t�' <br /> SI6NATU E �aisr� Y! N F�cuw�n Y/N <br /> i <br /> Ad <br /> Llcertsg0 � �. <br /> AN � /� � � '�����f .��C ' <br /> ELECT ,� / COMPANY �►-�! M ww�l//.� 'L; ��"• ��rr�1� <br /> Sk3NA u// REcfs�[-rt�n Y! N �ecutREti Y/N „lO��,tll�fr7 <br /> � �l1� � 'i ir/�_'� l <br /> � �� <br /> Add I License�i <br /> PtUNBE �j�r�� CONPANY <br /> 81GNAT '""�L"r-�, REQISTEqED V! N FEE cuaR� • Y/N <br /> OLi�nee k <br /> MECNAN! � ,/� r ^n,�f� <br /> �DNA E �`� OOMPANY �Y�h�+G�c+� l� (.(�� �' i <br /> �EGIBTERE� Y/ N F'E.E CU qqB, Y/N <br /> � �(L 'O ���' <br /> Licerwe# : � <br /> OTHER �MP�r <br /> �G�� �srQten Y/ N F�cuar+B. Y/N <br /> _� <br /> .. Llce�e 1t � { <br /> ■i 1 f 1 � 1 1 f � { t 1 1 � 1 1 1 1 1 / 1 1 � 1 1 1 1?1 1 ! 1 i 1 1 � 1 1 1 � 1 1 1 1 � 1 1 f 1 1 � 1 1 f 1 � 1 � � 1 � 1 � 1 1 <br /> RESt IAL Attach(2)Pbt Pkns:(2)sets of Buddhg Pla�:(1)sd of Energy Fomu;I�Q-W Permit tbr nawconstrudion, <br /> Mmanum ten(to)uwri�inH days alGer wibmiSMt dete. Requind unsi[a�eon�,ucuo�wans,s�om,waaer pan.,wr�n Fa�,ce i�d, <br /> Senlmry FatiGties 8 9 dump�;Spe Waic Pdrrnit(er subdyisionsAarge proJeds <br /> C�NER IAL Attad�(g1�pnPkEe se4 a4 Bulldin¢Plarre phis a Lile SafetY P+4�(1)aet aR Energy Forms R4W Petmlt(or new I 'wn. <br /> Mirtlrtwm ten(10)workin9 daYs aRsr su6mias�da0e. Required onsite.Construct(on Alans,Starmwate�Pla►es wY SAt Fwnoe' talled, <br /> Sanitary FadYties 81 dumpster.SRe WoAc Pqrmii far�new RrofeoW.AH oommerr3ai requhementa must mset odnpfan <br /> 91GN PER IT Attach(F)ssts of Engineered Plena. <br /> ""PROPER'TY SURVEY rer}uhad iw ell NEY�MnShucOOf1. � <br /> oi..ca � <br /> F�a apptice6o�compeaety_ .. �,j\ <br /> '^ � � <br /> &C.ontrecfor s(9n back ofaPD�GatiOn.fWtefixed : i <br /> n szsos,a t+o41�«comm�neemsne b..a,�.�ee. (AVc apg�aa.s ove.rsoa) ' �J'� <br /> i <br /> � '49 (fa��'o+�tr'ado�or Fburef of Attomey[fw ihe owner)wauld be someme with notarizgd letter from owner eut►pr��na same � � <br /> OVER COUNTEA PEitMflTING (Frtmt of MPRcation QnFYJ � <br /> R�ooTsjf 'ngles Sewers Service Upg�adea A1C _;Fencas(PIot/Survey/Footage) i <br /> i ] <br /> Orlve ayrNot ova Courtter If on public roadways,.needs RQW / <br /> ' G � S <br /> � �j � <br /> � �d I � <br /> Xd� 13C�13Sd1 dH WdOE =� �b T OZ 8 T 9a� <br />