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a13-7aao02o Gi�ly o��'��pnyrnins ►'C:f f I lIL HN��tt�n�.�v�� • <br /> Building 17o�artment <br /> � � . � . . � f��7 70�-�' . <br /> 33y n-_ ________ <br /> Date Racoivec� f i Pfiono ContacLiar Permitting _ _ __ _ __ - --- ------ �t i i r <br /> ��-�-�-�-�-ri-rt-rt-i-i-�-i-i-�-t-i-rri-i-r -1-I-I-1-hl-H t-1-I-1-TFIT-- -7e.�/�I/ <br /> -t-I-I-H-I-I-1-1-1-I-1-I-I-I- , 33 y �(¢�— / �`-�'j . <br /> �-� Ln ��;�,h� � OwnerPhoneNumber <br /> Ownor's Name �� • <br /> 3 3�� �'yj �C Dr • Owner Phone Numlier _, <br /> Ownor's Addross ' <br /> Owner Phone NuniUer C <br /> ree Simplo Titloholdor Name • , • <br /> f=�e 5lmple Ti[leholder Address , � <br /> ��t llc�'�`'� . .Ur� .. , ' LOT�k � <br /> JOl3 ADDRES5 `3"�� �� "�L` <br /> �O�t �/�/1�� �dil� PAI�CCL.iD;� as��-6 -�-/— G���Q�w �� <br /> SUBDIVISION � • � (013TAINED PROM PROPGRTYTAXNOTICL-) <br /> � ❑ ADD/ALT [� SIGN Q MOVC [� DGMOLISI-I . <br /> WORIS PROPOSGO ' NCW CONSTR r{[nAIR <br /> 1NSTALL • • . <br /> PROPOSBD L15C' • 0 S�R ' �• COMM Q . OTI-IER <br /> TYPG 01=CONSTRUCTIQN 0 f3LOCl� C� <br /> � FRAMC ' .�] STGCL [� OThICR <br /> �" �/�.�. <br /> DCSCRIPTION Of WORK �Q . • . <br /> Q � SQ f=00TAGE �7� I-IEIG[-I"f <br /> 13UILDING SIZC � x � , , . <br /> 13UlLDWG �U 4„"_� "" I Z VALUATfON OF TOTAL CONSTRUCTION , <br /> � � � <br /> PROGRESS CNCRGY W.I�.E.C. <br /> � ELCCTRICAL (� , . AM('SERVICE CI _ <br /> � PLLJMCiI.NG :G � � . <br /> 0 MGCI-IANICAL $ • VqLUATION OF MECMANICAL INSTALLATION • � j��I <br /> � <br /> � GAS 0 ROOrING � SI'ECIALTY 0 OTI-lER , <br /> 1=1NISI-IED FLOOR ELCVATIOfVS Z ,f�1..00D ZONC.AREA �YES ONO <br /> f5(J <br /> .--. • <br /> � � COMPANY OLlJ�2r , <br /> 13UILDCR �/fj� F2CGISTERED Y/ N C'GE CURRCNT Y/N <br /> 51GNATURC � ' ' . <br /> 33e1�"� � �cL'.�2! ��". ' ' . License�!� <br /> Adclrass ' E-� . <br /> GLCCTRICIAN r,�� � CQMPANY (.J�� • <br /> SIGNATURC �Ti`� RHGISTERG� �Y/ N r-��cu�tNr Y/N <br /> ����, �r • Lic�nse# <br /> Aciclres5 • <br /> pI,UMRGR • COM1'ANY <br /> SIGNATURC RCGISTERED Y/ N• f-GC CURRENT Y/N <br /> � License# I � <br /> Acldross <br /> MCCI-IANICAL ' • ' COMPANY <br /> SIGNATURE • REGISTERED Y/ N FEE CURR[NT Y�N <br /> • � ,License�#� <br /> Address � ' • . <br /> OTI-ICR • � . COMPANY <br /> sIGNATURC RCGISTGRED � Y/ N r-e�cutz�t�r Y/N <br /> . ' ' License�i � <br /> Address . ' _ _ -- - -- - - • <br /> - ---- - ------- - ----.- - -- ---- - R-O-W Permltfor new aonstructian, <br /> RCSID�NTIAL Atfach(2)Plot'Plans;(2)s�ts of I3uilclinc�Plans;(1)sel af Enorgy f=orms; <br /> Mlnimum ten(10)wori<ing days after suUmilfia!clale. Required onsite,CopsUuclion Plans;StormwaLer Plans w/Sill•1=ence instailed, <br /> • Sanitary 1=aeilltios&1 clumps(er,5ite Worlc Permit for subdivisions/I 1►'�J e[�of En rgy 1=orms.R-O-W Permil for now construction. <br /> COMMCRCIAL• Attacli(3)complete sefs of Building Plans plus a Liie Saf�ly Pac�o;( ) <br /> Minimum len(10)worlcing days afler submitlai dai�. Required onsite,Construcfiion Plans,SLormwater I'lans w1 Sill Pence inst�llod, <br /> Sanilary 1=acilities&1 dumpster.Sito Worlc Permll'For ali new projecLs.All commercial requiroments must meol compliance <br /> � S1GN PCRMIT Attach(2)sets of Engineored Plans. • . , <br /> �**�'PROPERTY SUf-iVEY r�quired for all NCW consiruction. <br /> ' -1-H-i-I-hl,-f-h1-1-1-1-hl-I-I-1-1-1-hFl-1-I-t-I-1-I-1-1-I-1-1-1-hl-I-I-1-I-I-I-(-1-f-1-1-1-I-hI-I-1-l-1-Id-1-l-FI-1-1-I-1-I-1-I-I-I-1-I-I-I-I-I-1-1-1-1-I-(-I-FI-1-I-1-I-I-I-I-1-1-hl-hl-I-I-PI-i-1-1-i-1-1-1-I-1-1-1-I-l-hl-(-I-t-1-I-1-I-1-1-I-FI-I-I-I-I-1-i-1-1-hi-I-1-I-1-l-I <br /> Diroclions: . • • <br /> Pill outapplicatton complelely. , . <br /> Owner&Contractor slgn bacic of appflcation,no(arized <br /> 11'ovec�2500,a Nofiice of Commencement is requirocl. (A1C upc�rades over:G5000) <br /> ** Agent(for the contracLor)or Powor of Attorn�y(for tho owner)would be som�on�wlth noYarized letl�r�From owner authorizing same <br /> •OVGR TI-1G COUNTGi�PCRMITTING (Fronl of Applicatlon Only) , <br /> RQroofs ' Sewors Sorvice.Upgrades AfC 1=encos(I'lafilSurvey/Pootage) <br /> Oriveways-Nol over Counler ifi on puUlic roadways.:needs ROW <br />