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<br /> , Biiilding epartrnent
<br /> . Date Eteceived Phaae Co for Ferm[fting � t�.JZ — . � . . .
<br /> i Qwne�`s�Na�ne I � S U v� OwnerPhone Nwnber " ��' � 1!
<br /> � Owaer's Address �� �t! � ' tl�mer Phane Nymber i � � ' •�,,
<br /> � Fee Sii»pte Tittetiotder Name Owi�er Phone Number��! ��?
<br /> Fee Simpie Ttteholdec Addr.rss . ' .
<br /> JO.B ADDRESS" � . '.�tOT# ��
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<br /> iN�RKPRtiFOSFD NEW,COEVSTR AD /At:7 [� 5lGN � ♦ MOVE' Q OEMOl.ISH :.
<br /> •- -• - -: • '� , ` , �;. INSTALI: � e EtE AIR- , : f.. _ _ � � , _ . . .
<br /> PROPOSED USE �_ SFR � Q `CO M � `��OTIiER • '
<br /> TYPE.OF CONSTRUC710N • [�] �BI:OCK �� -Q _ F , E Q ;• -STEEL � [�_.._:OTHER' : - . .
<br /> QESCRiPTfON OF WORK, ��t- - �`.�,•� � . . . , � -,. • . . � . �, '� .'
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<br /> � BU!l:D1NG 5lZE .�,..-.� -SQ FOl3TAGE . � ' HEIGHi` � " ]:, � '
<br /> � BUILDING $ VALIIA 10IV OF"fOTAL CANSTRUC7IGIN
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<br /> Q EtECTR1CAL $ 'AMP S R1/tCE Q Pi20C�RESS ENERGY Q'` - W.R.E.G.
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<br /> � MECHANICAL $ :VALUA.lON,OF MECHAIVICf1L lIVSTACl:ATIOlH �ij. ' � '
<br /> 0 c,AS Q ROOFl1+lG � sP c�A�nr [„� crrn�R . .,` � .. _ . . .
<br /> FfNiSHED FLOOR ELEVATiO3VS �i� -F!: OD ZONE A�2EA; . QYES �NO��� _ " .� . -
<br /> BUtLDER_ -- -- - -- - - COMPA[f4Y_ � .' .
<br /> SlGNA7"!!RE � . .REGIStEREO . �y�, N... , FEE.CUxrti�rrr, ��:w -Y 7 N - .
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<br /> ELEC3RlClAN CQMPANY - ' . . � '
<br /> �SIGNATURE REGis'�ltEO , Y/.N 'FEE CuRREriT - YY N
<br /> �Adii'sess � _ ' , LECense#'•V'� �
<br /> pLUMBER • . . COMPANY - � , - , .
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<br /> Address � � ' � ' - � L:icense#� " 1 •;. ��
<br /> MECHANICAL, � COAAPANY` • V ' ' • . . ,, -. . . -
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<br /> Address ` ' - � . License# ���
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<br /> Address �- - .. � ;'Cicerise# . , ����"�:�� .����
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<br /> RESIDENTlAL Attach(2j Plof Plans;(2)sets af Buitding Alans;(1)s of Eneigjr Forms-R-0-W.Pemilt for new aonstiu'cUon; ` -� � - �
<br /> Mlnimum ten{10)woAcing;days after submittal.date. equired onsite,:Ca�structtbn Plans,Stormwatar Ptans w/SitE F�ce+ristatted,
<br /> Saiv#ary Far,�7ifses&1 dumpsti?r;�fe Wark Pemtit for btlivis[onsllaCge pi4jeCtS , . . - ,
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