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Bull (ng Departrnent <br /> ln'�ei N a C(� <br /> Date Received � Phone Contact f.or Permittin �'6i3 2 4 �� �cl 6 S <br /> Owner's Name � �- , 1'� � Owner Phone Numb r ��,3- 783- Y!`�8' <br /> Owner's Address �-�x 2u rJ �L ,�, i 1 s Owner Phone Mumb r <br /> Fee Simple Titleholder Name �L 3 3 Sy 1 'Owner Phone Numb r �' � <br /> �� <br /> Fee Simple Titieholder Addreas <br /> 3 7 / 2 0 ��x R��•l iJ L Ze tiR h�ll s FC. 3 3 S� � r_� <br /> JOB ADDRESS Y LOT# <br /> � <br /> SUBDIV.ISION PARC L ID# ; i <br /> (OBTAINED FROM P OP�RTY TAX NOTIGE) <br /> WORK.PROPOSED B NEW CoNSTR 8 ADD/ T Q! SIGN Q ![� DEMOLISH <br /> INSTALL REPAI i <br /> PROPOSED USE Q SFR Q COM Q' OTHER ' � <br /> TYPE OF CONSTRUCTION Q BLOCK Q FRAM 0 STEEL Q ; � <br /> DESCRIPTION OF WORK �Q u ra t- C�+A N� c� �� O A�L 3S7'p,,.J /,� e2 /`�c�2i 2o n�?�� �e.�t� <br /> Py^1P <br /> BUILDING SIZE 3Q FOOTA(3E HEIGHT ' ; <br /> Q BUILDING $ VALUATIO OF TOTAL CONSTRUCTION ' I <br /> QELECTRICAL $ AMP SER CE � Q PROG E5S ENERGY Q W.R.E.C. <br /> [�PLUMBING $ <br /> OMECHANICAL $ �. VALUATIO OF MECHANICAL INSTALLATION � `� <br /> 7�J``�7. (�d � <br /> �, c� <br /> OGAS Q ROOFING Q SPECI LTY � OTHER , �� <br /> FINISHED FLOOR ELEVATIONS FLOO ZONE AREA QYES NO 1 ` <br /> i <br /> BUILDER C MPANY ;I <br /> SIGNATURE 4 �' ��'� R GISTERED Y/ N FE CURRE� :i Y/N <br /> Address Licens # �- <br /> , � <br /> ELECTRICIAN C MPANY � ; <br /> 31GNATURE R GISTERED Y/ N , Fe CURRE� i Y/N <br /> Address � Licens # � <br /> PLUMBER C MPANY � <br /> SIGNATURE R GISTERED Y/ N FE CURRE� � � Y/N <br /> �Address Licens # <br /> MECHANICAL C MPANY 't� I� 1�.G��S G�� S� � (�J� S p <br /> SIGNATURE R GISTERED � Y/ N FE CURRE� � '� Y/N <br /> i <br /> Address 1 Z. r�ss ia.rz o /3t+�J T��- F� �3�-i'� Ucens # �G f�C 1813�b�"r� <br /> � � ii <br /> DTHER C INPANY ' � <br /> SIGNATURE R OISTERED i Y/ N Fe CURRE� �; Y/N <br /> i , <br /> Address License# <br /> RESIDENTIAL Attach(2)PIoCPlans;(2)sets of Buiiding Plans;(1)se of Energy Forms;R-O-W Permit for ew construction, <br /> Minimum ten(10)workfng days after submittal date. equired onsite,�Constructlon Flans,S ormwate�Plans w/Silt Fence Installed, <br /> Sanitary-FaclllUes 8�1 dumpster;Site Work Permlt for ubdlvislons/large projects ' <br /> `-°..JMRIERG9AL-- Rtt�ch(3)-com^lato se�ts of Buf!ding Plans plu;;-�l_ife- afety_Page;(1.)set of Enerc�y Forms.R-O-W Permit for new constructlon. _. __ <br /> Mlnimum ten(10)workfng days after submittal date. equired onsite,;Construction Plans,S ormwafer Plans w/Sllt Fence instailed;�' -�� <br /> Sanitary Facilities&1 dumpster.Site Work Permit for II new proJects:All commerclal requi ments must meet'compi(ance <br /> 51GN PERMIT Attach(2)sets of Engineered Plans. <br /> ""PROPERTY SURVEY required for all NEW constrwctlon. ' <br /> lirections: '' <br /> Fill out applicatlon completely. � <br /> Oumer&Contractor sign back of applicatlon,notarized <br /> If over S2500,a Notice of Commencement is required. (A/C upg ades over 57500) <br /> ' Agent(for the contractor)or Power of Attomey(for the owner)would e someone with notarized letter from owmer authorizing same <br /> )VER THE COUNTER PERMITTING (Front of Applicatlon Only) <br /> �eroofs if shingles Sewers Service Upgrades A/C Fence (Plot/Suroey/Footage) , <br /> Driveways-Not over Counter if on public roadways..needs RO.W <br />