DECEMBER 2 2015 BUILDING APPS)o6-l\21<
APPLXEATION
iluBbel.
(oFft(e Use)
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t '1, t|NEII HANOVER COT NTY BUILDING PERI{IT
APPLICATIOII
N"E: RESIDET{TIAL
pLaAsE AXSiIER ALL QIESTII tS AppLICASt-€ TO yOU* PROIECT
'Project Respo slbLllttf
APPI-ICAI{I'S NII}IE: .Ej,lI Ctark gonler o, wilriri.lgtoD
Lr,C oATE: 11,/11/1s
OEVELOPER:
Bllt clark lromes
of wllnington
Lrrc PHOiIE Sr 91o.3so.t?44
pROrECt ADmESS: 4137 ph. Eotlot
Dr. CIW: rilningto!! ZI:p:. 2a4t2
SIEDIWSIO{: BelLe!{eadeBfocl(
*t LOT *: 20
PRoPERTY O IER'S
M E: ,8i11 clark aorne6 of lrilmltlgton IrLc
OiflER'S AITORESS: .127 Racine
D!. suite 201
CITYi wllmtnqton
sl: !g zIP: 2,!t!l
COIfRACTOR: 811.1
clark EolE€ of wilrd.ngroD
LLc LICE SE Si 34596
ADmESS r 12? Raclne Dr. Sui.re 201
CITY:WilninqtoD ST:
{g zIP: ?!1!i
EfiAIL ADDRESS: . rgill.@BilLctarldlo$eg.
com PtlO{E S: 910.350.17{{
PROIECT COf,IACI PERS(n
3 Richard
clII/Ei1I cLark Homes
of xiLnri-Egron Ptlo|tE *: 910.3s0.1744
EXrSTrr{c cfi{sTrucTro :
I llrenerron
! nr*mrroN
f] crrrnal nerurs
I REtocATIoN
NEH COI{STRUCTION;
EREET
Ell RESIDENCE
o"
! mrrrol To ExIsrI G RESIDENCE
..PLEASE CHECK AI{O A{SI'ER BELOT{ ALL THAI APPLY TO
\q',R PRO]ECT:
ATT GARAGE 510 SF
f] surxoon 5F
GREENHOUSE SF
! oer ormcr
I pool
! oecr
sr
fl roRot zrolr9" sF
I sronac sreo
oTHER: PaEto,16s
SF
SF
I No
t)sq7,u"
SEVtSao D
Tt 94111112
SF
5t
TOTAL HEATED
SQ
FT:
3226 ToTAL 5Q FT UNDER R@F: a1s4 TOTAL AREA
SQ FT: 4331e
TOTAL PROIECT CGT tassrorr : f rso,:so * OF
STmIES: 2
Is any ELECTRIC^L, PLUt'tBt {G
or XEO{AflICAL
tioik Eelrg Oone
to the Accessory Struct!.el
n yes
If the project
is a RetocationJ
ts there a llatural 6as Llne on
the Curent Site? lyes a No
Is there ELectrical Powen
on thls Buitding? Eyes llo
pRopERry rlsE
/ occrJpA
cy:
fl srncre rmrlv f[ u.rRlex
I routlrrousr
DESCRIPTIOTI OF [OR(: Nev conerructl,on
of 6i!r91e fam11y hone.
DISCLAIMEft I
My 6rdty har aI hbmrno. h lltE .pglbatbr, is
corEcl srd d lvork trfl comp{y wi'l tlc S!.iatulldho Cod6 rd d ohsr.pptc€tie Si.D eU tocd ta$sa|d
oftftltt * aE ,!0ul6thns Tha NHC D6\,ebp(ent Ssflbes Ceob. xt, br noigod ot&ly dia!€€s
h 6e 6proved pl8r 6
6nd spedtcatrons orconrlcE h brm6don. .-NoTE: Any lt/brt f,€fibnned
w/o ga Approprtab p6im1a wU b€ln Yroblbn
6r$6 NC SlaA Bldo To
isOCoo,'
Otlt{ER/CO fRACTOR
3 Richard ci11,/Bc:r
of HitrDilrgEon SIGIATURE:
*. r* *** rr* ***.** r "* '** * * ** JllllliTl,.," **
YESI5 TNE PROPERTV LOCATED IN A FLOODPLAT'{?
€XI$IllG IiDERWOUS AREA: o SQ FT
iIEI.I TIPERYICI,S ARE.A;
365? sQ FT
rurm: ffi creul
! co ru rTy svsmu
I
** **,1 * * ** **** ltr,*,1*
EXIST t.A'{D DISTURSING
PEiIIIT:
TI VEs I NO
PRIVATE }OELL
n
TOTAL ACRES DISTU
"*\]i.....'
RBED: .26
sEl{ERr
m CrpuA pRrvATE sEprrc
I couru-u:w svsreun
T'* SEPANAIE PERIIITS REQIJIRED FOR ELECT, I,IECHJ
PLS6, 6A5 Eq,'TP, PREFABS
& INSERTs
PAYTEUT MITHOD:
Dcosr
D CHEC( (PAYAELE TO r{HC)
D AHERICA'I EXPRESS,r*t***rt******:.**+t **,l,t:l*a,*
+*a* *i.,r**r + t:|,1*
*** 'l r *a
** *r,r
i.***a:}ir
**r*,***rr **a**** ****
zoflE:;- orrrcttr
5
(toi oFFtcE tsE tltY)
1i L',5npp"orrr, OLI _ crty: i-.,
L/r. oarE: ir F LOOD ;
k
5 ifi"tr l0r n Ir(
S ETBACKS:F
l-lkr()H1-,1
A\
;t RH:
-l5N(r'
a
I Nl(
Q
9urildr".[,.'"if
B:
BFE+2ft=
r:"1
PlioNE
$: 910.350.1744
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