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o�irrwrvvcu c.:�ry or cepnymms rermrc Appnca Iton Fax-s13�780-0021 <br /> Bullding bapartrnent • <br /> Date Reeetved � ' �r'��_��{ � photl0 Cordact for PermNttn �� • •• <br /> OwRe1's Nam• +C�A,vO '� el� V� � Owner pho e Number ,d�P"'���^.�� � <br /> owner's Addreas 37�0�'1 �n� Z • Owner pho ie Humher <br /> Fee Slmple Tltleholdv.Nama • Owner Pb0 liumbet <br /> Fae Simpfe Tltloholds'r Addreda � � <br /> Jo�noottess 3�'�� �In1.e s �or a . � � <br /> SuBDIVISION ' RARCELID# I�-d�-a � of�b--Q000a o�3a� . <br /> I ' � {08YA1 �ttaaPROpER1YTA1tND7�Cq ' <br /> WORK PAOPOSk"p ,e w�rhr cONSTR 8 AOD/ALt � SIGN � �] DEMdLISH <br /> IN3TAl1. REPAIR ' <br /> PROPQSEp USE � � SFR ,Q COMM [� OTHE � <br /> 7YPE OF CONSTRUCTlON Q BLOCK '•Q FRAME C� STEE � • <br /> pESCRIPTION.OF WORK . t'tY 1'Il.. V :•� <br /> 9UILDING SIZE � " 34�OOTAOE� ' HEIO T � <br /> QBUILDiNa S ' � VALUATION OF TOTAL CONSTRU IbN <br /> Q�RECTRICAL' S AMP S�RVICE � �f PROGR�SS'ENEf2GY [] W.R.E.C: <br /> . . . . <br /> �P�uM'sini� �..s . �. . ' , : ' , , . �� � � <br /> .[�M�RFIANrCAI. • S �1�� .�, � va�uAnoN oF MEC►(ANICAL IN ALLR71oN . •• � � <br /> -��� (yQ� <br /> �GAS• � ` Q� F20qFING �Q •SpECIAL•TY �' O?H ' �' (�1 �]�' � -�`1 <br /> u / <br /> FINISHED FLOQR ELEVATION$ FLOOD ZQN�AREA , YES .NO v !`.�t � <br /> U v <br /> 9UILdEit ' . .. ._ . ._. . ..,__. ._ :-. -.-�- •- COMPANY —: ., <br /> ..-... .. .... ....._ .. <br /> 81�NATURE RE�I87EREb Y'!' ' FEE cuRnen •' Y/•N . , . ._. <br /> Address � License#' <br /> FI KCTRICtAN , ' ' CQMPANY• . . <br /> SIONA7URE �GisrERED Y!M FEECURRE� Y/N• <br /> Address Llcense# <br /> PLUM9ER ' . • COMPANY . . . <br /> StGNATUR� ' REGISfERED - , Y! N FEE CuRREt� •Y/N <br /> Add�es9 Llcence#• � <br /> MECHANICAL /1 {J9�� COMPANY �S� � ' �/� <br /> SN3Np1yRE v'" REGISTERED N FEECURRE N <br /> Address ( a�3�+ • D6+Ql � License# � 'ds 7� . <br /> OTHER ' � ' COMPANY . . <br /> 9tGNATURE • ttEOlbt�aeo • Y N , FEE cuwsen Y I N • <br /> Address License#I. I <br /> RESiD�NT1AL Altacli(2)Plot Plans;(2)sets of Building Plane;(�)sek ot Energy forms;R W Fermlt tor new constructton, , <br /> ' •Mlnimum ten(10)worMng days after submiNal dBtC. Requlred onslte,Con ctinn Plans,Slormwat9r Pldns riv!Slit Fenr�'Installed,, <br /> Sanitary�edlitles&9 dumpstar,Slte Work Permilto�subdivlGlon6llarge praJ ets ' � ' • ' ' �� <br /> C0�1eAEftCU1L Atfach(3)complete sets oFBullding Plans plus a ufe sstety pag'e;•(1)•set dt nergy Farms:RA•W Pe�mit for new consVUCtlon. <br /> Minimum ten(10)working days aftel submiHai dale. Required onslte,Cons ction Pldns,Stunnvrdbar Pla�w/5ilt FenC@ mstalled, <br /> Santtary FadOtles&4 dumpster.Slle work permit for all new proJects.All co merclal teqWrements must meet complfance <br /> SION PERMIT Attach(2)seb of Engirlee�ed Plans. ' <br /> •"'PROPERTY SLIRVEY requlred tor ell NEW CDnsWcUon. ' <br /> Directtons: ' , . � <br /> FII out epplicatlan completeiy. <br /> Owner 8 ContractOr 5�baak oi app�icfltion,h0lA�ed <br /> (f ove►'iZ50Q,a NaNee of Commeneement is►equired. (WC upgrades over 57500) <br /> *• qgent(for IAe conUactor)or Power of Attomey(tor fhe owner}would be someone with no zed lette�fiDIN Owper authorSzing sBmE <br /> OVER'fHE COUNTER PERMITTINO (Frol1t Of Appllcatlon Only) <br /> Raroofs H shingles Sewers Service Upgred'es AIC Fencas(PIot/Survey/Foofeg ) <br /> Oriveways•Not wer Counter if on public roedv�raYs..needs'R01LV' ' • . , <br />