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, ._... -� asa•�excc�o City of 2ephyrnilis Permit Appiication F�-�s�.�ea-�az,
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<br /> DataReceived �' �ti�c �..�- � �-^�l'� �.� ;'� �� f •
<br /> Fhono Contaat{ar Percrfittin 1 - �')� �
<br /> •-r.•.�-i�-r-r-r�- �,�--.-,-� �_,_,. i..� .Y
<br /> ''hRDpl�1 $t�-7$3•9'!E ...�j � =
<br /> Cwners Nar.�e 1� ! •�"�� Owner Phane NurtS�r
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<br /> CwnersFddress pHnor Phano Number �
<br /> Faa S3my[a Tt#tebat6ar Name �T � Onner Pbone Number ���
<br /> F�e SImpIC TitleholdefAdAress f
<br /> J48ADDRESS 3��3� �Sa¢�a�-�t��v�� �FI'"•�r•Ii.I.S�j.rS LOTp �
<br /> s�so�vnstoN 1 � �ac�ce�taa ��"'�r�Z1�!C�—OCi Z17D-�dZ�t9
<br /> �00T0.1HE0 fRON PROrERTY7AX MOIICE)
<br /> WORKPROPOSED e rvfNmwS?n� ADD/ALT � SIGN [� [� DEMOUSW
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<br /> PRQPOSEOUSE � SFR � MOMAi � OTHER
<br /> 'TYPEOFCO`JS7RUCT10N �] 910C�C [� FRAME C] SiEE4 Q
<br /> pESCRIP71bN OF WtlRK ��F�GC^ �1�G�w �i�(3V�O^�
<br /> $�tLDtNGSiZE ( • � SQf00SAGE � rTD� HEIGNT � �'��
<br /> QBUILDING ri,��,,, ,,�,�.,� VAI.UA710N OF TOTAL CpNSTRUCTtON
<br /> L�.!�"'�' !
<br /> QELEGt�iCr�L �� A��P SERVtCE � PRDORESS EhERGY � 'Al.R.E.�.
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<br /> Otl�E41-IANICfJ. .� VALUATIGN OF fdECFiANICAL RJSTALLA'ION �
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<br /> QGAS � ROOFING Q 5PECIp1TY ��. OTHEQ � Q',.,'� '� f L�..�*�,._��
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<br /> FI�ISHEDFIOGP.EIEVATIGlvS � =LOODZQNEAREA �^ YES !�O �� � S.. �C��
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<br /> BU�tRER ^ r037pAVY l+�T�C� �bN"S�L1 G�E`,.Y'�• '.��
<br /> StGNA'E}RE rcecsrea.�n tJ FE�cux�er. � �p2�
<br /> Acldress pC�•� � 1 S Cioeme# f...i9'���7��"
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<br /> ELEC7RICIAW ,,. +�^COMPANY I
<br /> SIC7IVATURE , REGi5T�_D Y/PI FEE CURREP "!h1
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<br /> A�dlC55 '._.•• L(C2tI5$Q� j
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<br /> .�-ti Pl.UMBER �j ��+ COMPANY �.,'.;;,�
<br /> t�r.�3 �S(GNATURE �f �"'"` ~ � ��s,srES�o [ Y!N FcECUSee� YtN��
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<br /> ��.fi' �y�.nddross l��� kJc �� W.I(u, i�.!' L ,�C/ .. '� licensex � �
<br /> "j��'4� Et1. GHANICAL �:.s :, COMPIWY
<br /> SIC,NATURE 4EG4iTCRcC Y!h FEELURP.EA �/N
<br /> Add=ess CiceaseA E i
<br /> OTHER � � COh9P�NY
<br /> SIGNATIfqE �EGtSTEftED Yt N fEELURAEt� Y/NS
<br /> Ada25s � i Licertse� ! ^�
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<br /> RESIDENTipt Astach{z}p�o{pEens;{2}seis ot Built6ng Pta�s:{'�set o'Energy Fomts R-�W perneit Sor neiv consl�uUiars.
<br /> Minimu:n te�(t�y Kc�rkii�days a9ersubmitlai date,i2equireG cnsi(e,ConsWCtiqn Pfans.Stonnwate�PWns w/S�t Fenca irataRed.
<br /> Sanitsn FaeSfias 8 1 dumpster:Sito NJonc Pemtit torsub�ivlsionsnarpc projecla
<br /> COic1MERCIAL Anach(3}com�lete sets o13ui1C.ip P�ans plus a Lile Satety Page;(1)se�ot Fna�gy Famrs,R-6-VJ Pemiit frr new constvdinn.
<br /> lNin:mum ten{i Oj unrkinp Cays 2fter suhmitta!date_Required onsite,Canslluctian Pl�sns,Slamiaaier PIaRS wl5iit F�ce'anta43eQ
<br /> Sani.afy Fa�Skes d i tlurnps7er.Site Work Pernut for ap new�ro�ects.Alt cammefcial reauirements must meei cornpli�nc.z
<br /> SIGtJ PEAMI7 �Itacfi(21 s_Is a Engineare.�1 Plans
<br /> "^PRQP'eRTY SURVE�requiredtar nit NEYJ cwuwaion.
<br /> Directions:
<br /> Frn out aqF�Lcation corr.�letey.
<br /> Ovmer&CoNracror sig�back oi app@cation,rwtanzed
<br /> if over 52540,a Noiice of Cammence�er.t is regWred_ (iUC upgrades over 57500)
<br /> " Agenl;`or!he coNractar)ar Power o(Altofrey(for Ihe ovmer)w;uttl ba someorw N4th nota=zed letler trom o��ner aatlmfiiin�sarne
<br /> OVER TNB COUNTER P�RMI'iT14G �Frotu af AppGtaiion Only)
<br /> Reraaisitslimgtes Scnrers ServiceUpgrades A'G Fencxs(FIOL+SurveytPootage}
<br /> Uriveways•Not over Covmer if on p¢bGC roarlways,.needs Rd4"J
<br /> �'d 1�6b6968E98 ��� '6GId xo� •�p�eyai�
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