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aas-�ou-w�cv �,i�y ui �GNi�yii�nis r�iiin«,NNn�:auvii .......... ... .. _. <br /> Buitding D partrnent t <br /> yYt O h!e`C!� <br /> Date Rece�ved Phane,�ontact f,or P ctt�it#�n �eS t 3 �'..�R - `� (o5y` � <br /> , <br /> Owwner's Nazne 3 G�. N N i /1(1 Ow�er Phone Number '1'3 - �„t8 • �`"��'�-. . <br /> Owner"s Address Owner Phone Number f � � <br /> Fee Simple Titleholder:Name- . Owner Phone Number �� ^ � <br /> Fee Slmple Titleholder Addreaa - <br /> JOB AQDRESS ��� �C� fJ�u @ �/�`t e�}v-k? �(�11R�(Le+'��S �L 3'3 S`�' LOT# `�'�. ,, <br /> .r.._ .... , ,. , . <br /> SuBQIYI,SIQN ' 1. �-,,�5`( ��-n-eS � PAitC�L I f 3 -2Co --Zt-C��O p-Ope�d�- C�3 2d . . <br /> ,� (OB7AINED�ROM PRQPERTY TAX NOTICE) ' <br /> WORK�PRO,iT�OSED � NEW COMSTR 8 ADD/A1.T �� SIGN Q Q DEMQ�tS}� <br /> � ' INSTALL' aEPAIR <br /> Pl20!?t)SED.USE. - [�. SFR Q CQMM � OTHER <br /> TYPE.OF CON37RUCTION Q 9LOCK [� FRAME � STEEL Q <br /> DESCRIP�ION�OF-WORK ��2up-l. GI�RN,, epr.�,. O� �![- Z'.° S�'aN I3 S,�� S{CG�.f �"7'G��i2drJ�'A',, <br /> ��„ ���p4�n ' <br /> .-. _ <br /> BUILDING SIZE SQ FOUTAGE HEIt3HT _� , " <br /> ����'d��� $ VAI.UATION O T07AL CONSTRUCTION � � <br /> [.�s�o. �� <br /> [�61.ECTRIGAL � � AMP SERVICE Q PROGR�SS�NERC3Y Q W.R.E.C. ' <br /> [�Pk,lltV�BINt3 � � � y��� ,. _ , <br /> �/[ ' / <br /> QM�GHAIVIGAL $ VAt»UATiON.O NIECHANICAL INSTALlATIQN <br /> QGAB Q RQQFfNG Q SPEClAL '� OTHER . <br /> FINISHED FLOOR ELEVATIONS L�� FLOOQ Z NE AREA QYES NO <br /> BUILDER COM ANY _ <br /> SI.GNATURE RBGIS EREp Y/' N FEE CURREA� � Y/N > • , <br /> Address t,icense# � _ � <br /> ELEGTRtC1AN CCiM ANY <br /> SIGNATURE � REGIS R8D Y/ N FEE CURRE� Y L N <br /> Address l.lcense# � � 1 <br /> PLUMBER� Gt7M ,ANY <br /> SIGNATUR� REGIS EREp Y/ N FEE'CURRE� Y/N <br /> Addreaa �icense# � � � <br /> MECMANICAI:. 2 � ' - Ct}M .ANY � 1L2 SGLf�. � � _ ' '�,.=re�'�`" : „ <br /> SIGNATURE- - � REOIS EREp Y/ N� Fe�CuRrx�n Y,/:N�`:� -- � - , .•- <br /> Addresa� „ � Z l?SS'f2�v f3�+��T�A+�o',a- F '33 4 f� �icense# f C.�f'�� ��S'l 3 3'���. <br /> OTH�R;, ` COM ANY <br /> SItiNA7URE RECiIS REp Y! N FE�CURRE�. Y.LN <br /> Address l.Icense# � � <br /> REStD�Nt#AI.• Attactt{2}p1a#Plans;{2}sets of Bull�ing Pians;{1}.set of Energy Facros;R-0-W Permit for newncanstsuctian, <br /> ` � Minimum ten(1Q)workfng days after submlt�al date. Req (red onsite,Constructfon Pians,$#ortnwater-Plans w1 Silt Fence instailed, <br />-- - - - � . -Sanitary;Facilitles&_4 dumpster;Slte.Wo�lc Rermft for su ivislonsllargQ projects - - �- <br /> COMMERCI�A1. Aftach{3}complete sets af Buitding Plans plus a�lfe Sat fy Page,{ij sek o#Energy Forms:�R=O=W Pem'tif"for'r.eu+.consWction�� _ - f <br /> Minimum ten(10)working days after submittal date. Req ired ansite,Construatlon PI&ns;Stortnwate�Plans w%Sllt Ferice inshdlled; <br /> Sanitary Faclilttes&1 d��mpster.Sito-iNork-Fe,•srtt-io�ail ew proJects.All commerctal requlrements must meeC compliance <br />�_ ���N�E;�Mi7- � Affach�{2)sets.-of Engineeced Plans. � <br /> ""'PROPERTY SURVEY reyuired for all NEW constructl n. ., � <br /> .. . . .. <br /> Directlons; . " . , � . ,-- <br /> Flil out appitcatlan completely. - : � F <br /> C�umer&Contractor sign back of appl(ca�on,notarized - <br /> tf ovec;Z2300,a Notica of Con�mencement is required. (A!C upara es aver 57500j <br /> "• Agent(far the contractor)or Power of Attomey(for the owner)would be omeone.wikh notarized lett�r from ovmer authorizing same <br /> OVER THE CCIUNT�R PERMITTIN.G (Front of Appilca�on C7niyy <br /> Reroofs if shingles Sewers Service Upgrades AIC Fences( Iot/Survey/Faotage) <br /> Ipriveways-Not ovar Gaunter tf on publia roadways..needs RUW - <br />