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� , <br />� � i <br /> ` Dete Recelved Phone.Cont�ct fo�Pe Itti I (p <br />� - - d <br /> Ownera Neme fi� � � l.L 7 Qwner Phon�Num I r �3-�]�-'�'7� <br /> Ownera Addresa 3$O 3� �T� �-2_ QwnQ�Phone Num I t !. <br /> Fee Slmple Titleholder Neme Owner Phone Num r <br /> i <br /> I Fee Slmpie Tilleholdet Addroee <br /> i <br /> � w/7e9. <br /> JOB ADDRE88 3 F{.. .�S/ LOT NS I.1 .�1 a� <br /> SUBDIVISION FD B Z.-hrI PARCELIDq �I-26-�I-ODI " � �O-� 1 (O <br /> (dBUUHBDfROM CPERTY AXNOTICE)' <br /> WORK PROPOSED B NEW CONSTR B AOD/ALT SION [� Q DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SFR Q COMM OTHER I I ! <br /> TYPH oF CONBTRUCTiON Q B�OCK Q FRAME STEEL [� I , <br /> I DESCRIPTION OF WORK G 2 S I�J S I � .K l.t '�"F � P <br /> BUILDINO 81tB Sq fOOTAOE HEIOHT I ' <br /> 08UILDINO 3 VALUATION OF T TAL CONSTRUCTION <br /> QELECTRICAL 3 AMP SERVICE Q PRO E8S E, �ROY Q W,R.E.C, <br /> QPLUMBINO a <br /> � �. ,��� <br /> �MECHANICAL $ VALUATION OF ECHANICAL INSTALLATIO � <br /> O <br /> IQOAS Q ROOFINO Q 3PECIALTY OTHER <br /> FINISHEO FLOOR ELEVATIONS FLOOD ZON AREA QYES NO <br /> � <br /> I <br /> BUILDER COMPA Y i <br /> SIGNATURE " REaisTER D Y N F ' CURRE� Y I N <br /> i <br /> Addresa Llcens # <br /> ELECTRICIAN • COMPA Y � . <br /> 31(iNATURE qeoisrea o Y N F CuRRen Y/N� <br /> Addresa llCenB # <br /> PLUMBER COMPA Y � <br /> SIONATURE • rtEO�sTe o Y! N F CURRE�' Y N' <br /> Addreae Llcene # <br /> MECHANICAL `�-� �� COMPA Y R ,4L'SG �"� � � Sp <br /> SIONATURE REp18TER D Y/ �� F cun en' Y N. <br /> Addreee l Z Ass�2 0 /31�J q. FL 33�.��'� ucene a G ' S 3�3(05° <br /> OTHER • COMPA Y i <br /> 910NATURE � REOi9Ten o • Y N Fe CURREAI Y/N <br /> Addresa Licena t� <br /> �ESI�ENTIAL Attech(2)Plot Plena;(2)aete of Buliding Plena;(1)set of En y Fortna;R•O-W Permlt for ew cone' cUon, <br /> Minlmum ten(10)warking days aker submit►al dete, Require onelle,CansUuctlon Plens, miwate Plane wi 311t Fence inatalled, <br /> SeNlery�FadllUea d 1 dumpeter,Slte Wotk Pertnit(orsubdivl lons4afge proJects <br /> :OMMERCIAL Atlech(3)complete sete of Bulldin8 Plane plus e Llfe 9afety. age;(1�set oi EnerOY Fortne -O-W R rmil for new consWcUon. <br /> Mlnlmum ten(10)working days after eubmlHel date, Requlre onslle{�ConstrucUon plans, ortnwate Plene w/Sllt Fence tnslalled, <br /> Sanitary FedllUes 61 dumpster.Slte Work Pertnit(or ell new roJecls,All commerclal requl mante� Ust meeC compllance <br /> 31aN PERMIT Aftech(2)aets ol Englneered Plane, <br /> ""PROPERTY SURVEY requlred for ell NEW conaUucGon, <br /> ]Irectlons: <br /> Ftil oul epplicatlon cflmpletely. <br /> Owner 8 Contreclor slgn back ot appllcetlon,notadzed <br /> It over 52600,e Notice of Commencement li required. {pIC uppraden ver f7500) <br /> ' Agenl(for lhe conVactor)or Power of Attomey(Ior the owner)would be aom one wlth notarized IeMer fro owner e' horizing eame <br /> )VER THE COUNTER PERMITTINO (Front of Applicatlon Only) i <br /> ieroo►s I(shingles Sewere Service Upgradea A/C Fencea(PIoN urvey/Footage) � <br /> DrlveweyrNot aver Counler If on publlc roedweys„naede RO.W <br /> , � <br />