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\ � <br /> Building epartment ��J�'_ � {.}-i� <br /> � � <br /> Date Receiveil �� ��-1 g. <br /> Phone,Contact for .ermittin �`3 h - �� �S <br /> Owner'�Name L{��n(L 1'�- S`ra ��� Owner Phone Numb r �S ^�'3 5 -7 O� _- " <br /> Owner's Address Owner Phone Numb r <br /> � <br /> Fee Simple Tttleholder Name � Owner Phone Numb r <br /> Fee Simple Titleholder Address <br /> � <br /> JOB ADDRESS S � �-t� � ^ -- Z2�'►R` I'1�I�S F�, ��z LOT# �� <br /> SUBDIYISION S� i l}-C.�'.�. O��CS PARCEL ID O3-?�o-�I�d I�� '�Q���''Q 8�� <br />'_ ' (OBTAINE�FROM P OPERTY TAX NOTIC�) <br /> WORK.PROPOSED B� NEW CONSTR e ADDlALT� Q SIGN [] � DEMOLISH J � <br /> INSTALL REPAIR <br /> PROPOSED.USE Q; SFR Q COMM � OTWER - <br /> TYPE OF CONSTRUCTION Q I BLQ .h1E-- STEEL Q <br /> DESCRIPTION OF WORK J` 4 �"���c.I�2rJ � �9(,}�L.. . <br /> � <br /> BUILDING 31ZE �— i � S FOOTAGE HEIGHT <br /> � BUILDINO ,' $ �(' f �� ZS VALUATION OF OTAL CONSTRUCTION <br /> 10 10 <br /> ELECTRICAL $ ' _ , �` AMP SERVICE PROG ESS ENERGY Q W.R.E.C. <br /> ,; P) <br /> �LUMBING $ �C��l7O� ODZ' S�'�,`'b <br /> � � � <br />� OMECHANICAL $ VALUATION OF� ECHANICAL.INSTALLATION � <br /> ��' `���2 <br /> QGAS Q ROOFING Q SPECIALTY � OTHER <br /> FINISHED FLOOR ELEVATIONS ' FLOOD ZON AREA QYES NO <br /> �' � � G r�-�.a :�' <br /> .. .� <br /> BUILDER COMPA Y �L bw-eS. l�aM�, CeNT�2s � �!c-; <br /> SIGNATURE REGISTE ED Y/ N FE CURRE� Y/N <br /> Address O QO u � G��J 2�A��'y 3�'$7"� Licens # G6G f Sc� ��I 7 <br /> ;� �`£ � <br /> E,C'I'RICIAN �A ��OMPA Y , ��►6�.� aJ �l � � S�i 2ee�( ""r'�.�,z(cGlt <br /> SIGNATURE REGISTE ED Y/ N FE CURRE� Y/N ; <br /> Address �o r�c�X �f 3� �A�C: FL '3,'�5'Z� Licens # � (- ���0 13 B'3 <br /> PL MBER / �COMPA Y �o l��t+aJ Pl�, �iks� ry "Tqr+�� i�oy de. <br /> 51GNATURE � REGISTE ED Y/ N FE CURREA Y/N <br /> Address O �d7< �23� S P�.��9j'►: 11 '�'L '3' .(a� � Ucense# �PG �`-t Z�'''�.,:�4 <br /> MECHANICAL. , COMPA � <br /> 51GNATURE REGISTE ED �/ N FE CUitRE� Y/N ' . <br /> , <br /> Address ' I License# <br /> i <br /> OTHER COMPA Y ; <br /> SIGNATURE ' REGISTE D Y/ N FE CURRE� Y/N . <br /> Address � License# ' <br /> � <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of Buliding Pians;(1)set of En rgy Forms;R�O-W Permit for ew consUuctlon, <br /> Minimum ten(10)-working days after submittal date. Requlre onsite,Cons�ctlon Plans,S ormwater Plans w/Silt Fence installed, <br /> Sanitary,Facllides 81 dumpster;Site Work Permit for subdlvl fons/large prdJects <br />-��*!M��G@A!: - Attacti-(3j ca^;�fetg s�to o`Su'.!dfng Plans plus,�Llf�r Safety-�.a�s;(-1}-�st-af-Erie�y Furtns. .-t�-�1V-Germlt f�rne���,c��st,��tian—-_--=------ <br /> Minfmum ten(10)working days after submittal date. Requfre onsite,Const�uction Plans,S ormwater Plans w/Silt Fence lnstalled, <br /> Sanitary Facflities&1 dumpster.Site Work Perm(t for all new projects,All commercial requir ments must meet compllance <br /> 31CiN PERMIT Attach(2)sets of Engineered Plans. � <br /> """PROPERTY SURVEY requlred for afl NEW construcUon. <br /> � <br /> )irect(ons: , <br /> Fill out application completely. _. , <br /> Owner&Contractor sign back of application,.notarized <br /> If over 52500,a Notice of Commencement is requlred. (A/C upgrades; ver ST500) � <br /> ' Agent(for the contractor);or Powe[of Attomey(for th'e`owner)-would be so eone with notarized letter from owner authorizing same <br /> . .. <br /> )VER THE COUNTER PERMITTING_= (Front of Application Only) <br /> teroofs If shingles Sewers ,� Service;Upgrades WC. ':: Fences.,(Plot/ urvey/Footage) <br /> a:.. _,...-,.r ... _..4 : . _ ,. <br /> Driveways-Not over Counter if on public roadways..needs I#OW <br />