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.. .. ..._ .,.._.. .���� .,� �..N���������� � ..�����.. .rr,�......�..�� <br /> Building Department <br /> Date Re�e ved � � -��j� Phone�ontact for PermltNn $ �� Z 6 S <br /> Owner'a me (� � /i r f� i L i.�M Owner Phone Number 2 a! ' 3`"� 1 ' �-�2�-( <br /> Owner's dress Owner Phone Number I �„ � <br /> Fee Simpl Titleholder Nama � Owner Phone Number � � <br /> Fee Simpl Tkleholder Address <br /> JOB ADD ESS �1 �� 1 1 �'1 S� ZP.��tRY�i I I i S F L 3 3 S�f 2- LOT# i l <br /> SUBDIVI3 ON M�v�2e S /sT Rd�,I � PARCEL ID# �`f -��-2/ ' O�lo - ��."70�- (� t�-� <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK P P08ED e NEW CONSTR B ADD/ALT Q SI(3N Q Q DEMOIISH <br /> INSTALL REPAIR <br /> PROP08 D USE Q SFR [� COMM � OTHER <br /> TYPE OF ONSTRUCTION � BLOCK Q FRAME � STEEL Q <br /> DESCRIP ION OF WORK iA�+2 �- w i ,.o i•+i1'S �r�-e. Si F�- 1�b�� <br /> BUILDIN S�ZE �� 8Q FOOTA(3E� HEI(3HT �� <br /> � UILDING S � ,S-1� ��D VALUATION OF TOTAL CONSTRUCTION <br /> �] LECTRICAL $ AMP SERVICE Q PROC3RESS ENERGY Q W.R.E.C. <br /> Q LUMBINC3 �� �i—' �/ q <br /> Q ECHANICAL 3 VALUATION OF MECHANICAL INSTALLATION <br /> � I \ I <br /> Q AS Q ROOFING Q SPECIALTY � OTHER <br /> FINISHED FLOOR ELEVATIONS � FLOOD Z�REA QYES NO <br /> P c: ca�e.a �' <br /> BUILDER �J� C MPANY (.QW. S NoM�, Gea��2s` � iJ C- <br /> SIGNATU E ' � � � REOISTERED Y r N FEE CURRE� Y/N <br /> Aaa gs c> �o� � � �i3 ��'A�t�� �z���' ucense# G�oG � SO ��1� <br /> ELECTRI IAN COMPANY <br /> SIGNATU E REGISTERED Y/ N FEE CURRE� Y!N <br /> Add ss License# � � <br /> PLUMBE � COMPANY <br /> 81(3NATU E REGI3TERED Y/ N FEE CURRE� Y/N <br /> Add as Llcense# <br /> MECHAN AL COMPANY <br /> SIGNATU E REGISTERED Y/ N FEE CURRE� Y/N <br /> Add sa t License# � <br /> OTHER COMPANY <br /> 31(3NATU E REOISTERED Y/ N FEE CURRE� Y/N <br /> Add ss Llcense# I <br /> RESIDEN IAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Fortns;R-O-W Permit for new construct�on, <br /> Minlmum ten(10)w�n►king days after submittal date. Requlred onsite,Construction Plans,Stotmwater Plans w!Silt Fence Installed, <br /> �an!tar�FadllUes� 1 Cumpster;Site Wark Permit for subdlvisi�nsAarge projects <br /> COMME IAL Attach(3)complete sets of Bufiding Plans plug a life Safety Page;(1)set of Energy Forms.R-v-W Pe�mit fa�naw oona��cUcr.. <br /> Minimum ten(10)working days after submittal date. Required onsite,Constructton Plans,Stormwater Plans w/Slit Fence installed, <br /> Sanitary FadllNes 81 dumpster.Site Woric Permit for all new projects.All commerclal requirements must meet compliance , <br /> SICiN PE MIT Attach(2)sets of Engineered Plana. <br /> •'""PROPERTY SURVEY requlred for all NEW consUucUon. <br /> Direction : <br /> Fill o t appNcation completely. <br /> Own r&Contractor sfgn back of appllcation,nota�ized <br /> If ov r t2500,a Notice of Commencement is required. (AIC upgrades over tt500) <br /> "' Age t(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner autho�izing same <br /> OVER TH COUNTER PERMiTTIN(3 (Front of Applicadon Only) <br /> Reroofs if shingles Sewers Service Upgrades A!C Fences(PIotlSurvey/Footage) <br /> Drlv ways-Not over Counter ff on public roadways..needs ROW <br />