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e��-7so-oo2o Gi�Cy o�C G�pnyrni��s r�r��u�Hl�i�<<�n��v�, • <br /> . Building DoparfmonL <br /> � . � . � . � �/3 ��. - 5��� --------=-� <br /> �:_ --- ---- <br /> PlZOneConfiacCi'oPPermiti:ing ---- -- <br /> Date Receiv��I -------------------- -rrt-t-t-r�-► ------- -►-I-c-I---- --- <br /> ---- -- - --- -- ---- • <br /> '19-hti-►-1-I-t-1-I-l-i-I-1----- - :J �f7`-��' Owner Phone Number <br /> owner`s Name��c � ��� . ' <br /> � 7�d� ���(���� • �(� owner Phono NwnUer <br /> Owner's Address <br /> owner 1'hono Nunilier <br /> I Pee Simplo Titlehofder Name • , . ' � � <br /> I=ee 5imple TiLl�holder Address , � �.OT�f `�`O • <br /> � 75��-• �'�2�-s-��°%� �� . � . <br /> JOB ADDRGSS • . d���—QOO(J(J-` ���� <br /> _ - _ j/C�! �f�-�- ' - PARC�L.(DfF ��-02-� �' - - - � -- - <br /> 5UBD1V15ION � ' � {OBTAIN6�PROM PROPGRTYTAX NOTICG) - <br /> • ADDlALT � S�GN 0 MoVG � DGMOLISI-I . <br /> WORIt PROPOSCD ' NCW CONSTR n �G�A�� <br /> � INSTALL • - �-a : OTI-IL-R <br /> pROPOSED L1SC' � � � pLOCIt � COMM L� OTI-lCR <br /> ' rRAMG ' .� STCCL � <br /> '�YPG OI�CONSTRUCT(ON � � . . <br /> :���� � -�uiJ� . . <br /> p�SCR(PTION 01=WORK ' , . � ' <br /> f� � X/o�-� SQFOOTAGC ��y 1-IC[GI-IT <br /> I3UILDlN�SIZG • , • ' <br /> RUILQING �I� �'SQ d� VALUATION Of-TOTAL GONSTRUCTION . <br /> PROG S CNERGY - Q �N.f�•E.C. <br /> � ELGCTRICAL ;G , , . AMP SCRVIC L� . , <br /> . . � p ��..z <br /> PAS�O 6��f��AIT S�RIIlC� <br /> �; Q . <br /> � pLUMBLNG ,I • � � (���}7�6-sr314 <br /> ,, . VqLIJATION ol= -CI-IANICAL 1NSTALLATIOI� •��1��2�_7$94 <br /> � MCCI-IANICAL �I� . � <br /> ' —I ROOFINC � SPCCIALTY � OTI-ICR \�ti�'� <br /> � GAS L�1 <br /> I=1NIS1-IEDFLOORCLCVATIONS. FLOODZONEAREA [�Y�S QNO <br /> , <br /> . , � � ' �C��/` `s � ' ��' . <br /> , �1 ,� CoMPANY fGE CURRGNT Y/N <br /> I3UILpGR � �'�'���� �i f2GGISTCftED Y/ N , <br /> 5IGNATURC • • <br /> (2��lJ'�'� �Li . � / �'� • ' . License�11� <br /> Adclress KQ� • <br /> ' . COMPANY <br /> GLECTRICIAN [ZEGISTCR�O , ' �`� N FGG CURRCNT Y/N <br /> SIGN,0.TUI3C ' <br /> • • License�t <br /> Aciclress . . � <br /> ��UM��� • ' COMPANY <br /> RCGISTERED Y/ N• fGG CURRENT Y I N <br /> � 51GNATURG I� <br /> . � Licenso# I <br /> Addross . <br /> ' • • COMPAIdY <br /> IVICCI-IANICAL � ' Y/ N F'EE CURI?GNT Y(N • <br /> RGGISTGRED <br /> SlGNATURC ' � � ' . <br /> • � .L'ICense�#� <br /> Acldress ' ' , . � . • <br /> • COMI�ANY Y/N <br /> OTI-IER • � . RCGISTCRED � Y I N �CG CURRGNT <br /> SIGNA'I'URC . � <br /> • ' ' License�t <br /> Address � ---- -- -- - -� <br /> RCSID�NTIAL Attach(2)Plot Plans;(2)sets oi[3uil�linc�Plans;('l)set of Gnergy Forms;f�-�-�1 Perm1L•for new construction, <br /> Mlnimum ten(10)worlcing days after submillal dale. Required onsite,Copslruc(ton Plans;Stormwalor Plans w!Sill C'enoe fnstailed, <br /> • Sanitary 1=acilitfes&1 clumps�er;5ite Worlc Permil fidr suUdivisions((1�se[�of CnergY:Forms.R-O-W Permit for new consiruction. <br /> COMMGRCIAL Atlacli(3)complete sets of 13uilding I'lans plus a L.ifo Safely I'age; <br /> Mlnimum[en(10)worlcing da��aSitr�WomiE�a�l m1��o all�ne�ojecls A�I commerc�1 roqurromentsimust meo[•l o�mplianc��sfalle , <br /> Sani[•ary I=acilities&1 dumpsi <br /> ' 51GDI PCRMIT Attach(2)sets of Engine�rod Plans.� • • • <br /> ****PF20PERTY SUftVEY required'for all NCW construction. <br /> ' -FI-1-I-1-1-f,-H-I-1-hhh1-1-1-1-I-I-1-1-i-I-l-1-I-I-1-1-1-I-hi-1-(-1-I-I-1-I-I-1-I-1-l-I-1-Id-1-FI-I-1-1-1-I-I-1-(-1-1-1-I-I-I-1-1-1-1-1-I-I-1-1-1-1-1-1-1-I-1-I-1-I-1-I-1-1-1-1-I-I-1-I-I-I-1-1-(-hI-I-I-I-(-i-1-I-1-1-1-1-1-I-FI-1-1-1-I-hl-l-1-1-1-1-I-1-I-1-1-I-I-I-t-1-1-i-1-1-h(- <br /> DirecLions: . • ' <br /> Cill out application completely. . • <br /> Owner&Con[ractor sic�n Uacic of application,notarizacl <br /> If over�Z500,a Nofiic�oC Cammencement is requirecl. (AIC u��grarles over:G5�00� <br /> k* Ac�enl(for the contracLor)or Power of Altorney(for the own�r)would Uo someone with notarized lefiler'�rom owner authorizing same <br /> •OVCRT(-1GC011NTCC�.PCRMIT'I'ING (f-'rontofApplicationOnly) . <br /> Reroofs ' Sewers Sorvice Upgrades AIC �onc�s(Plo1/SU�veyl�ooiage) <br /> D►•iveways-Nol over Counter if on public raadways.:n�eds ROW <br />