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�8�.�•(�U-U��U LJity U) LGt.Jtiylli(I/ t t.i�..�ta r ar�....va..a.....
<br /> Buftding epartmenf
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<br /> . Date Received � � . � ?��7 _ j��'}5-
<br /> Phane Contac far Permitting �: �, i�.� � ��
<br /> Owner's Name. � 1 � � �j V tJ�i x Owner Phone Number "- � � � — . .� �i
<br /> Owner's Address �� � � � Owner Phone Number � rf
<br /> _. , .�. � . �'i
<br /> � I
<br /> Fee S�mple Ti#ieholder Name Owner Phone Number�� �!�
<br /> �i
<br /> :,
<br /> _ ��
<br /> Fee Simple Titlehalder Address
<br /> JOB AQDRESS ��� � • LQT# �.
<br /> SUBDIVISION, �n I�t- �U,��1�!��(���J ;PAR EL.ID# 1 r�lV�Z.l � D� 1 � "b5.b0(�. =0C�I,c�:: `,
<br /> ` � (OBTAtNED FROM FROPERTY TAX NOTiCEj
<br /> WORfC PROPOSED NEW CONSTR ADD L7 Q SIGN � MOVE Q DEMOLISH
<br /> . . - .� .. . � e lA3STAlL e FtEP tF2 � � .
<br /> PROPOSED USE , [^ SFR 0 COM [ ,�/ OTHER
<br /> TYPE QF GONS'it2UCTiOAI Q ��OCK 0 FE�A E Q STEEL � CITHER "
<br /> DESCF2IPTtON OF WORFC: �I . I � Y'V4 �� . . .
<br /> ' ' • . ;
<br /> BUILCl1NG SIZE ` SQ FOOTAGE HEIGHT C- _ �
<br /> � BUILDING ��{1, �,r'1� VALUATI N QF TOTAL CONSTRUCTION , I �' 1
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<br /> � ELECTRICAL � �I AMP SER ICE [� PROGRESS ENERGY Q W.R,E.C,
<br /> �
<br /> 0 PLUMBING � �
<br /> 0 MECHANICAL � � VALUATI N OF MECHANICAL INSTALLATION � _
<br /> Q GAS Q ROOFING 0 SPE IALTY Q OTHEFt .
<br /> FlNtSNED FLOOR ELEVAI"iONS � F�t3 D ZONE AREA �YES QNO
<br /> --BUILDER__...__ ._...�.----_.. _ _ — _ -----.__—f_— --- -- - OMPANY.-- • � . : . ,
<br /> SCGNATiJRE GISTEREp Y t N ��E cut2�zEt�s '-- Y t N - � -
<br /> Address � � License# � . ' '' �
<br /> ELECTRICIAN dMPANY � � �
<br /> Si�NA7UR� GISTERED Y I PI �FEE CtFF2RENT 'Y I R{
<br /> Address • License#' � ' �
<br /> PLUMBER OMPANY � �
<br /> SEGIVATURE R ��s7eREO Y 1 N FEE CURRENT Y!t+I
<br /> Address License# �- �
<br /> MECHANICAL OMPANY � '
<br /> S16NATI�E2� R GlSTEREC} Y I �) FEE CtlRt2ENi' Y i N
<br /> Address � License# � �
<br /> OTHER OMPANY �- � l�lJ� 1S � � S� ' �
<br /> StGNATURE% R GISTERFCt Y/ IU FEE CURRENT Y I'N •
<br /> Address � � ' '..License# ���-�������
<br /> RESIDENTIAL. Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of nergy Farms;R-Q-W Permit far new canstruction,
<br /> Mfnimum ten{10}working days after submitta!date. Req ired onsite,Construction Plans,Stormwater Plans w/Silt Fence iristalled;
<br /> Sanitery Facilities&1 dumpster,5ite Work Permit fbr sub ivisionsJtarge projects � ,
<br /> COMMERCIAL— AEtach(3)sets afBuilding Plans;(1)set of Ene�gy Forms.R-O-W Permit far new canstruclion.
<br /> Minimum ten{14)work�ng tlays after stsbmittat date. Req ired onsite,Gonstructson Plans,Stormwater Plans w!Silk Fence insta4lecl,
<br /> 8anitary Facitities&1 dumpster.Site Work Permif for ati n w projecfs.AIt commercial requiremenfs musf ineet compiiance�� �
<br /> SIGN PERMIT Attach(2)sets of Engineered Plans. � �
<br /> **'*PROPER'E"Y SURVEY requ3red for ali NEW cans#tvcti . . , � �
<br /> Directians: , , , ,
<br /> F3II out application complete[y_
<br /> Owner&Contractor sign back of apptication,notarized
<br /> If over$2500,a Notice of Commencement is required. (A/C upgrades ver$5000)
<br /> *' Agent(for the contractor}or Pawer of Attomey(for the awrier}woutd be so eone with notarized letter fram owner authorizing same
<br /> 'OVER 7HE COUNTER PERMI7TING (Front of Application Only)
<br /> Fteroofs Sewers Service Upgrades AtG Fenc {PiatlSurveylFootage}
<br /> ___... .. -. ... .,�. �.. ,.r.......�. ..�.,,•_r;,
<br /> Driveways-Not av,er Counter if an pu8lic roadway,s::needs�ROW �� � �- °� •���'�, � °" ""'' ; �`'" , ,
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