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813•/t7U-UUGU l.rll�/ UI t ���yu�n�u � �..�n u�i.p.p...v........�
<br /> Buiidtng Department '
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<br /> Date Received i � ' Ph ne Confact for Permitting � ,
<br /> . �re �c.� l 3 '��1.�'� f���' �;
<br /> � owner's Name Owner Phone Number __,,
<br /> , Owner's Address 3�5b`� �i`� � w�°h u� Owne�Phane Nurinber
<br /> . .:. '
<br /> Fee Simple Titleholder Name . Owner Phone Number� �'�
<br /> ' Fee Simple TitleholderAddress .
<br /> JOBAD�RESS• � ISC)!� ��' ��'� ► �� ,G�ittS �, 335�f � �.or# .��
<br /> SUBDiViS10N �
<br /> (d,YtS�f �5���-F�� 1;PARCEC:ID# .IZ' �-.2I-� �j3ao-- o.c�ooc� - .d�7o .
<br /> - - ' - ' - - -- � -- -— .- - - -�— . -�(OBTAINED FROIN PROPERTY TAX NOTICE)
<br /> WORiC PRQPOSED e NEW COF�tSTR ADD1Al.T` � StG��� MOVE Q DEMOLiSN
<br /> '� � �� � � INSTALL RLPAIR @� �
<br /> PROPOSED USE , Q SFR � GOMM Q QTHEtt � � '
<br /> TYPE OF CONSTRUCTION Q ,BLOCK FRAME Q STEEL Q QTHER � •
<br /> DESCRIP,TtON.OF WORK; {,CAfi lS�-� C�A�L� (Z��U -�' ��s S • V W�S C,t�f�i r'1 ' . ,
<br /> BUIl.DING SIZE �� :SQ FCiOTA E�� HEIGH`f C ._. � .
<br /> Q BUILDING � •� VA�t1AT10N OF TOTAC G{�NSI`f2UGF'IOIV . ,,
<br /> � 2;,�5�•l`>� - , - .
<br /> Q E�ECTFtICAL' � �{ AMP SERVICE Q PROGRESS ENEf2CY . [� W.R,E.G.
<br /> i
<br /> � P�un�B�r��. I � . �Z'�
<br /> Q MECHA(VICAL $ VALUATIOlV OF MECl1AIVlCAL IIVSTALLATION � `�
<br /> Q GAS RQOFiNG SPECIAITY Q OTHER
<br /> FINISHED FLOOR ELEVATIONS � . FLOOD ZONE AREA QYES QNQ �
<br /> � _BUI�DEF3_ __. � _._ _ _ _ _.-----._._---- - GOMPANY_ ,
<br /> StGNATURE REGISTEREp Y/ N . FEECURRENT `YIN
<br /> l�C�t1(g'SS �.�C£Ii58# �.. . . ' �
<br /> � �
<br /> , , .
<br /> ELEC'fRiC1AT�1 COMPA�+1Y . .
<br /> SIGNATURE REGISTERECI Y/ N �FEE CURREtJT ''Y/N
<br /> Address l.icense#� '� �
<br />! PLUMBER � ' CCtMPANY
<br /> SIGNATURE � r.E�ls7'eR�o. Y/ N FEH CURRENT' Y/N ,
<br /> Address I�icense# � � • �
<br /> MECt1ANICAL � COMPAl�tY � �
<br /> SIGNATURE REGISTEREp Y J N FEE CURRENT' Y J N
<br /> Address � - l.Ecense# , C , � �
<br /> 03FIER -CtaMPA�+lY CL t3.s'� ! �"b��'1 V1 q :.L:Y1c , ° • ,
<br /> SIGNATURE� —� REGtSTER�D Y N FEE CURREN7 Y 'N ,
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<br /> .- Address -3 fv�l-� --�t--�? rh i t t sr-_�2_ _ 33 'r��t-- - -- — ';L.tcense# �.�./�'�:c�.S�a�-
<br /> REStDENTiAl. Aktach{2}P1o#Plans;{2}sets of Building P ans;(1)set of Energy Forms;R-Q-W Pertnit for new canstruction,
<br /> Minimum ten(10}warking days after subm ttat dafe. Required onsite,Gonstruction Plans,Stormwater P1ans wl Si1t Fence iristall.ed; �
<br /> Sanitary Facili6es&1 dumpster;Site Wor Permit for subdivisionsllarge projects , � .
<br /> GOMMERGIAL Attach{3}sets of�Suilding Plans;{4}set af Eneigy Forms.R-�-W.Permik far new canstructian. , �
<br /> Minimum ten(10)working iiays after subm t#al dafe. .Required onsite,Construction Plans,Sformwater Plans.wi 8ilf Fence instaited,
<br /> Sanitaty Facilities&1 dumpster.Site Wor Permit for all new proJects.All commercial requirements must meet compliance�' � ,
<br /> SICflI PERMIT AEtach{2}sets of Engineered Plans. . � .
<br /> **'*PROPERi"Y SURVEY required.far all EW constructian. .
<br /> Directions: ' � -
<br /> Fiil out apptication comptetety. , -
<br /> Owner&Contractor sign back of application,notarized , � ,
<br /> 1f aver$2500,a Etotice of Gommenaement is requlred. AtG e�pgrades over$50Q4) � - ' i
<br /> *` Agent(for the contractor)or Pawer of Attomey(for the own r)would be someone wikh notarized letter from owner auihorizing same �, � �
<br /> OVER THE G011NTER PERMiTTING (F�ont of Appiication nEy)
<br /> Reroofs Sewerr�• •---�Serv3ce Upgrades:,,..�.,� C:, :.. Fenaes(PIotlSurvey/Footage}:�.�;�.,:,.3,��y�, , _.v.-... '
<br /> ey � ;i"•� �;_s;,l_ ., ; , ,,,., � '' ,...� �i ��"�' ';lE^ .� --_ _._' � „ _z
<br /> Dr"sveways-Na#ave�.;Coanterdfon�public5raadways..needs� OWf =����J�' M _,,,,� ., ., , . .�
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