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.wr +.,.�.. i,Jli� V/ LVr,iIlJ/�ti/IV � VI��t�at �Nrt���,nw��v�i <br /> Building Deparkment <br /> .� <br /> Dats Rece ved � phone�ontact far Permittin 1 3 z.�0`1 -- � <br /> Uwner"s e M R R-► A o Owner Phone Number �'�3 ��3'3 ^'S'�J 8p <br /> Uwner's dmsa �R n► Owner Phone Number ( �, � <br /> Fee 8impi Titleho{dar Nsms � � Ownsr Phana Number � 1 <br /> Fee Simpl Titleholder Addre�s <br /> ,�os,�w� ss 3 �{`3(o T Z. 1�; °3 S f? e.a�r� �o <br /> susonr�s H {��P�+a 1��l 1�� t�,aRC��to� -�.5-2 t- ca o so- a Qd vnn --O �� <br /> (OBT111NED FROM PROP'ERTY TAX NOTIRE) <br /> WORK P �POSED NEw COlUS'I'R ADDlAL7 � SlGIV Q Q DEMOUSH <br /> e lNSTALL 8 REPAtR <br /> PROPOS D USE Q SFR [„� COMM C� OTHER <br /> TYPE OF ON8TRUCTiON Q BLOCK Q fRAME � STEEI. Q <br /> OESCRIP ON OF WC}RK J � S� #�- i Z q t <br /> �—'"'� C� �_� ►_�. t + 3`f 2 <br /> eu��.oir� srz� sat�caa7ac�� ���t��r <br /> Q U14DlNO � VAi.UATfON Of TQTAL CpNSTRUGTtON <br /> 23a'7, i 3 <br /> [� L�CTRICAI. [$� �( AMP SERVlCE Q PROORESS ENERGY [] W.R.E.C. <br /> I—., _.___., J <br /> [� LUMBlNC3 �� � � <br /> [�] ECHANICAI, $ VALUATION OF MECHANICIAL INS7ALLATION � ��` <br /> � <br /> [� AS [� ROOFINCi Q SPECIAL.7Y � OTHER <br /> FINISHEp FLOOR ELEVATIQNS ��w-� FLOOD ZONE AREA [�YES NO <br /> G C��.a �'Z`' <br /> BUI�DER � �� �� OMPANY L Gt„i-e.S �Io�<, G �T�.lZS' �f./c. <br /> $IGNATU E ��� � RECiISTEREQ Y/ N �E CuttFtE� Y!N <br /> aaa� �� o �o� � �'t � �.�'R�,td� ��-��� uc��,ge# G�aG 1 S C� �'�-t 7� <br /> Ei.ECTRI IAN C4MFANY <br /> SIGNATU E REt3f$TEREO Y/ N FEE CURREh Y/(V <br /> Add ss L.icense# � � <br /> PIUMBE �� COMPANY <br /> SIONATU E REG115TERED Y J N FEE GURRE� Y I IV <br /> Add ss i.lcense# � � <br /> MECNAN L GOMPANY <br /> SIGNATU E REGISTERED Y! N FEE CURRf� Y 1 N <br /> Acid ss Ucense# 1 t <br /> OTttER �-_-� COMPANY <br /> 81(3NATU E REOI3TERfp Y t N F£E CURRE� Y!N <br /> Add ss License# t � <br /> RESlDEN !A!. Attadt(2)Plot Plans;(2y sets of Building Plans;{1 j set of Energy Forms;R-O-W Permit for new cansUuctlon, <br /> Minlmum ten(10}woricin�days aft+e�subtnittal date. Raqutred onsite,Construc�on Pians,8toarrwater P1ans w!Siit Fenc:e instatled, <br /> Sanitary,Fadlitleg&1 dumpster;Si;e Work Permit for subdfvlsfons/large proJects <br /> CQMIt'�EI�GIAI. Attach{3}t�m�ete ssfs of 8uti�ing�{ans plus a G`�Saiety Page;;1!set�t Energy Forms.R-4-W Permit for new construcUon. <br /> Minimum ten(10)working days after submittal da#e. Required onsite,Consfnactlan Pians,StormwaEer Pians w!Sitt Fenc�s ins#alted, <br /> Sanitary Fadlitles&1 dumpster.Site Woric Permit for all new proJects.All commercial raquirements must meet compliance <br /> 81{#N P'E MIT Attach{2}seb af En�neered Plan$. <br /> '•""PROPERTY SURVEY requlred for atl NEW conshucdon. <br /> Directldn : <br /> Fitl o t applicatlon completely. <br /> Ovm r 8 Contracta�sfgn back of appHcation,notarized <br /> N ov r t2lW0,a Notica of Commsncement 1s roquired. {A/C upgrades avsr�tS00) <br /> "• Age t{for the contractor)or Power of Attomey(fur the owner)would be someane with notarized letter from owner authorizing same <br /> OVER 7 COUNTER P�RMITTINti (Front of Applica�on Only} <br /> Reroofs If shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage) <br /> Dri ways-Not over Counter if on pubiic roadways..neads ROW <br />