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a�3-7ao-o02o GI�L'y o�i'�epnyrn�ris r-��:r�►uc�j.�I��,L��tu�, . -- ' Huiiding DoparEm�nt Dale R�c�ivec! �— . � pllono ConiaciiarP�rmii�in� ��3 �� . -- r�/ T � -----=- � '�'1-�"��'1'�'1'�-j•�-I^�'I'I'Ni'hI9-rn-rn-rn-rrrrrn-rn-rrrrn-rr�-ri-i'i'�-n-i'!'hl'1-S'f'PF}-1'hLl-4-1'1'hhI-FPI'hl-F-I'I'YI'I'I'YI'«l°rl'��-I-�'t' - --- ""'_- -- - '-- c.___ _ {f�(1 I. Ovirner's`Name � �pY`<. �d��! '� ��/� c�wnerPhoneNumber � ' � Owner's Arldress � ��Q pY'�'� � e, • �-e v1��1�5 Owrter Fhono NumU�r� � Cee 5impio Tittet�oi�ter Natne • Owner I�Iiona 1ltumfi�r�� t=ee Simpte TiLiehoicier Addr�ss � • • ' JOBADDIi�SS � 'Y-}Yl. 1...f�k2 Y• �.2.� Yl v1�i11� '�'l. 33��c� LOT�� S - � . . ; � • . suBa�vis�or� � - �t-c�Y-,e,ns Chclen s'��v�,-� �.�r�c�r.►n� c�3-��-�-� -o�s t�-o o c�b - ��g b � , • ' GpY� (OpTA(NE�F[�OM PROPERTYTAX htOTt�C) WOI�tC PROPOS�D ' NEW CONSTR ADf?lAI.T � SIGN � MOV� [� DGNlOLlS!-! , , �. (NSTALL . . � f��i'Aif� PCtOPOS�D ll5G' . [� 5f R ' �• COMM 0 t7T1-1�R " - -�-jrnc or-corasrr�ucri�r� �( ��.ocit � ' t=i�AME • .Cj s-reeL C( o-ri-i�r� � � ro o ,�,..X�s� G�,cc�u " � - p�ser�tnT[atv or-wor��c • .�c�ree 5 ' � I3UILDING uIZG �rk�r r � sc�r-oar.a�e�'LC�.�^� I-I�IGI-17' �—� � 13UlLDlNG �� d �p • � VALUATlON OC TQTAL GONSTRUCTION 0 EL�CTRIGAI. ;j; , �� AMP S�FtViC� � !'ROGIiESS CNGI�GY � J� W.R.E.C. � i'LUiViBW� :(i ��{ . � ��«�E��¢�� 0 MECi-(AtdiCA� �; VqLIJATlON OI=MECi-IANICAi�1NSTALLAT(O(� � ��3��'�31� . ' � • ' �� 43C 9�a2�-��. (� GAS �] ROOrlNC � SPGCIALTY [� OTF[GR , �"� � � riNiSi-IED FL,001�El.EVATIONS l=1.QOD ZONCAREA �YGS �NO �� • ' . • ; ` : .-. � 13UIL.DCR ' �� r COMPANY �1'�1�'�e� an b � Y ".i-�6 '`�'4� \�• i .w SIGNATURC '� Rc��s��b Y! N r-ec cur�ctvT Y/N � Adclress c��Y7e�S�•C� - ' . License�l� � � GLCCTCttC1AN • GOMPANY SIC,NATURE R�GtBTCREp ° �Y/ !V PL-�CURRCNT Y 1 N Adctres� ' • Lioonso� �� —T� P!»UMt��i� . � CaN(PAN� SIGNATUR� Rc�isre[�a Y! N. r-cc cur�r�et�rr Y/N , Addross License� C � M�CI•IANlCAL ' • ' GaMPANY 5IGlVATURC • - REG(STGRL-D Y! N rcc cur�r�etvr Y/N . Acic[ress • • ;Lioense�!�� j QT!-lGl� . ' , CONIPA�lY ' . , . aiGNA't'lJi�C RGGISTE�iED ' Y/ N t�C cuRrtcNT Y!N Acictress � . License# �T � � I�GSID�NTiAi. AEtaci�(2)i�fot'Pians;(2)sets of 13uilciinc�Plans;(9)se�ai Gtl�rgy'Forms;I�-O-W Permttfor n�w consfruafion, Mlntmum ten(70)worictng days aftcr suUmiEta(daEe. Reqtiir�d an�iit�,Canstruction Plai�s,8iormwater Plans w/SI![t=ence instaltect, ' S�nitary Facilitl�s&1 c]umps�er;S'sie Worlt Permit•.iar suUdivisionstlarc�e�rojecis . COMMCRCIAL AfEacli(3�comniofic s�ts of I3uiiciing Pians plus a LPfe Saf�ty l�ac�o;(9)s�t of Gnergy.'Corms.I�-O»W!'armtt far n�w consfirucfion. Minfmum ten(14)worlting days aflei submlEta!dat�. Required onsife,Consituction Pfans,S[orrnwater t'lans w/Slll C'�nco lnstall�d, Sanit�ary Facitities,&1 dumpsfer.Sito ulfor(c 1'�rmtl'for all new projects.A!!commercIal rQqutramenfs mus[mee[comp3i�ne� ' S1GM PEI�11l1JT Attach{2��sets of Enc�ine�rod Pians,� - �`*'"*f'ROI'ERTY SURVEY requIror!•for a!!NEW aonsfirucUon. � • , , ' -1-l-l-1-l-l-l:1-1-M-l-l-]-1-I-1-1-1-1-1-Hhl-I-I-I-I-I-t-I-I-(-I-I-I-ti-i-I-i-t-i-t-J-FI-I-1-i-i-I-i-I-I-1-1-1-I-I-I-2-t-t-t-1-i-S-td-i-t-Fl-S-i-t-i-l-t-l-i-1-1-t-1-I-1-1-Id-ld-1-I-1-l-l-l-1-l-i-1-1-1-1-I-1-1-l-1-l-1-I-I-1-I-ld-1-1-l-1-1-1-1-1-I-I-1-I-t-I-FI-t-Mht-I-t-i-i-hl-I nirec[ions, Pii!ou!appltcatlon complotely. � • Own�r&Contractor sic�n bacic of apnfiaation,natarizecl ' � I!`aver�250D,a Notice of Commancoment is requIrod. {AtC upr�rad�s ov�r:b5Q00} ** Ageni(for the co,ntractor)or Power of AtEorn�y(•For fii�c�•own�r)woufd be sam�ane wtYl�notarized lefit�r firom owner authorizinc�sam� • •OVCR Tl-1G GQUNT�13.PC1�MITTlhiG (Ftont af Applicafiion Onfy) ' • I�eroo(s " Sewors Sorvic�.Upc�rad�s A!G C-�nc�s{PloilSUrvey/�oofi�ac�e) ' . Driveways-IVot over Gounter ifi on publlc raadways.:n�eds l�QW �