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Building D partment <br /> , � C <br /> Date Received � �'('3 -2 c� _C�c��5 <br /> � Phone,.Contact tor P rmittin <br /> Owners Name �R�YYIe S �-- , h�'i�1 .� Owner Phone Numb r �l3 ��:g2 • J`���S <br /> Owner's Address 3$7�� � 2-� ��''� ' Owner Phone Numb' r � <br /> � , <br /> Fee Simple Titleholder Name i Owner Phone Numb r <br /> i <br /> Fee Simple TitleholderAddress <br /> � <br /> JOB ADDRESS 3�7 � ; � r27h ��- z��''2y ' �1 S FL 3 3�`► LOT# � � <br /> S4IBDIVISION PARCEL ID � ��.�c-�►� '00�� -8�ZOC� ' � �C�O <br /> � (OBTAINED'FROM P OPERTY TAX NOTIGE) <br /> WORK:PROPOSED , NEW CONSTR ADD/ALT � SIGN Q Q DEMOUSH <br /> B , INSTALL 8 REPAIR - <br /> PROPOSED.U3E Q,i SFR Q COMM � OTFIER <br /> TYPE OF CON3TRUCTION Q I BLOCK Q FRAME � STEEL _Q <br /> � r <br /> DESCRIPTION OF WORK ���'A�� �-3 �� v+ � I-�i,y' G��V N iZ '� C� w�`Tl� 2 ���e�' <br /> i <br /> BUILDING SIZE I SQ FOOTA(3E HEIGHT <br /> �BUILDING $ �28� Q� VALUATION OF OTAL CONSTRUCTION <br /> QELECTRICAL $ ; AMP SERVICE Q PROG ESS ENERGY Q W.R,E.C. <br /> QPLUMBING $ ; �b� <br /> � \5 <br /> QMECHANICAL $ VALUATION OF ECHANICAL INSTALLATION � \ <br /> �GAS Q ROOFING Q SPECIALTY Q OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZON AREA QYES NO <br /> � zP G �-+e.� �.� <br /> BUILDER � COMPA Y L ow-es l�oM�e, CeNT�2s �,,1,�� <br /> SIGNATURE �- ��� REGISTE ED Y/ N FE cuRttEn Y/N <br /> Address O aOK � ��J ��A��'' ��'�7� Licens # �roG .S(� �3 � <br /> ELEC7RICIAN COMPA Y <br /> SIGNATURE REGISTE ED Y/ N FE CURRE� Y/N <br /> Address Licens # � <br /> PLUMBER COMPA Y ' <br /> SIGNATURE ' REGISTE ED Y/ N FE CURREA Y/N <br /> Address Llcense# � <br /> MECHANICAL COMPA I <br /> 51GNATURE REGISTE ED Y/ N FE CUFtRE� Y/N � � <br /> I <br /> Addresa � � License# � <br /> i , <br /> DTHER COMPA Y I <br /> SIGNATURE � REGISTE BD Y/ N � Fe CURRE� Y/N <br /> � <br /> Address � Lfcense# ' <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of En rgy Forms;R;O-W Permit for ew consUucdon, <br /> Mlnimum ten(10)working days after submittal date. Requly d onsite,Constructlon Plans,S ormwater Plans w/Silt Fence installed, <br /> Sanitary,Facilitles&1 dumpster;Site Work Permit for subdiv sionsAarge prdJects <br />;,OM�dERCOAL---Attach-(3;-campf3t3�s;s�of`��fiding Plans plus a Life Safety- age;(1?-set af En�rgy Forms. -�-W Permit for.new constructton._�__.___- . <br /> Minfmum ten(10)working days after submittal date. Requir d onsite,Constructfon Plans,S ormwater Plans w/Silt Fence installed, <br /> Sanitary Facilitfes 8�1 dumpster.Site Work Permit for all ne pro)ects.All cbmmerclal requir ments must meet compliance <br /> i1GN PERMIT Attach(2)sets of Engineered Plans. � <br /> """"PROPERTY SURVEY requlred for all NEW construcUon. <br /> )(rections: <br /> Fill out applicaUon completely. _ <br /> Owner&Contractor sign back of app�Ication,notarized <br /> If over b2500,a Notice of Commencement is requlred. (A/C upgrades ver 57500) <br /> ' Agent(for the contractor)or Power of Attomey(for the owner)would be so eone with notar(zed letter from owner authorizing same <br /> )VER THE COUNTER PERMITTING (Front of AppllcaUon Only.) <br /> Zeroofs If shingles Sewers Servfce Upgrades A/C Fences(Plot/ unrey/Footage) <br /> Drlveways-Not over Counter if on public roadways..needs ROW <br />