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8�13-78�-0020 Gi�Cy o1'��pnyrn�iis ►��:ui�i�r�N�����n«�„ • <br /> Building Do�artment <br /> � ' - --- ----1-LU-i-t-rrri-r <br /> Dato Rocoivecl --�(�—I Phono Coniact for Permitting -��r -t-l-t-i-�"- /� <br /> - -- - - ------ - ---- ---- -r►-►-►K-rt-� - ---- -- Q � � • ���' Z 9 y?f I <br /> -1-1-I-H-1-I-1-1-1-I-1-hhh---- -- -- -- � <br /> —r ' Owner Phone Num' <br /> Owner's Name �A � • � , <br /> � � 1 ( Own�r Phon�Num�er 1� - � � � �-�6 `� <br /> Ownor's Acldross 5 � � ' <br /> Owner Phone Nurrib�r <br /> ree Simnlo Tilleholdor Name • , • • <br /> I=ee 5imple Till�f�older Qrldress • <br /> • � j� �.or�t / O � <br /> JOB ADDRCSS 3 5 � . <br /> ' • PARCCL ID#� Z ' 2 6 ` ' � � O • � <br /> 5UI3�IVISION � - • (Of3TAINGD fROM PROPGRTYTAX N07'ICC) <br /> ' ADDlALT 0 SIGN [� MOVE �] DCMOLISI-I . <br /> WORIC PROPOSCO ' NGW CONSTR � ���,A1R <br /> � INSTALL • • . <br /> PROPOSGD L15C' ' . � SI=R ' �� • COMM � OTI-IER <br /> 13LOCl� � � PRAMC � .� STCEL �] OTI-IGR <br /> TyPG Or CONSTRUCTIQN � , <br /> . . 32 � 1� .� . <br /> DCSCRIPTION OP WOR �.1� V . . , <br /> QLIILDINC�SIZC 3 Z. � � SQ 1=00TAGC 3 8`I� <br /> I-IEIGFIT � <br /> � 13UILDING � � ' VALUA N 0f=TOTAL GONSTI�UCTION � ? 61 p Q� <br /> PROGRGS - ERGY • W.R.E.C. <br /> Q ELCCTRICAL Ir , y AMI'SERVICG I�_ , <br /> - �i ���( 1.�+'. , <br /> �,� PLUM[31NG ��� :t-�� �; . ��l� _ . <br /> � M�CI-IANICAL � � VqLUATION 01=MECI-IANICAL INSTALLATfON .�t <br /> 0 GAS 0 R001=1NG [� SPECIALI'Y 0 OTI-ICR , <br /> 1=1NISI-IED FLOOR ELEVATIONS �LOOD ZONE AREA �YCS QNO <br /> � • <br /> ' I � COMPANY v^�� . <br /> (�3UILDCR � FEE CURRCNT Y/N <br /> `��IGNATURG F2EGISTHRE� Y/ N <br /> . . . • . Liconse� <br /> Addrass � . <br /> � Q �,v CQMPANY �`'", � <br /> �LCGTRlC1AN ^T ��GISTGRGO ' �Y� f�1 PCG CURRCNT Y/N <br /> IGNATURC G • <br /> , ' • Lic�nse# <br /> Address • <br /> � y.;.i COMPANY 'E� <br /> LUMRCR v �{CGISTERED Y/ N• FCG CURRENT Y/N <br /> 1GNATURC <br /> � Licanse# <br /> Adclross <br /> MCCI-IANICAL ' • ' COMPANY <br /> 51GNATURG • • ReGIST�R�D Y/ N f GG CURR�NT Y/N <br /> • � .License�� <br /> Address • ' • . <br /> OTI-ICR • � , COMPANY <br /> S1GNA'fURG RCGISTCRCD � Y/ N r-Gc cuRrteNT Y/N <br /> . ' ' License# � <br /> Address ' _ _ - <br /> --- - ------ - -- -.- - - -- --- -- -- ' 13-O-WPermltfornewconstructian, <br /> RC5ID�NTIAL Attach(2)Plot'Plans;(2)sets of DuilcJinc�Plans;(1)sel of Cnorc�y I=orms; <br /> Mlnimum ten(10)worl<ing days after submitl•al dale. Required on�ite,Copsfruclion 1'I�ns;Siorm�nraler Plans w!Silt f-'ence fnstalled, <br /> � Sanitary 1=ae111tlos&1 clumps�er,S(to Waric Permil fior subdivisions/larg5e�of Bnerc�y.�f-'orms.R-Q-W Permil for new construcUon. <br /> COMMCRCIAL Attacli(3)complote sets of l3uilding Plans plUs a Life Safely Pac�o;(1) <br /> Minimum ken(10)worlcing days af[er submittal dafie. Requirad onsite,Consfruciion Plans,S[ormwater Plans w!SiiL f-'enco Instaliod, <br /> Sanilary(=acilities&1 dumpster.Sita 1(Vorl<P�rmit�(or all new projecls.All commerciai requirements must meel compliance <br /> � 51GN PCRMIT Attach(2)seYs of Engineered Plans.� • . . <br /> ****PROPERTY SURVEY r�quired 1`or all NEW consfiruclion. <br /> ' -I-1-1-I-I-i-1-FhI-1-I-I-I-t-hl-i-I-I-I-hFl-1-l-I-1-1-I-1-I-I-I-1-hH-1-H-FI-I-1+1-I-1-I-I-1-1-1-1-I-i-1-I-hl-l-ld-I-l-hi-hl-1-I-I-I-1-I-1-I-I-1-1-I-1-1-Fh]-FI-I-1-1-i-1-1-1-(-I-hl-1-hI-I-1-1-1-1-1-1-I-I-I-I-hI-i-I-1-hFl-I-l-1-I-1-1-FI-hl-1-i-1-1-1-1-hl-I-t-1-i-1-I <br /> �iroclions: . • • <br /> P(II ouL apppcatlon com[�IeYely. , . <br /> Owner&ConlracLor sfc�n Uacic of application,notarized <br /> II`over�2500,a Nofiice oP Commencement•is roquired. (AIC u�grades over:G5000) <br /> ** Agenl(for the co,ntractor)or I'ower of,4ttornoy(for ihe owner)would b�somoone w(lh notarized lett�r from owner authorizing same <br /> •OVCRTI-iC COUNTCf�PCRMiTTING (1=rant of Application Only) , <br /> Roroofs ' Sewors Sorvice Upgrados AIC 1=onc�s(1'IoUSutvey/l=ootage) <br /> Dri�eways-Not over Caunler iF on puUlic roadways.:n�eds ftOW <br />