DECEMBER 4 2015 BUILDING APPS?otS - 1t33,.{
\q-3)a7 I
APPTICAIId{
llrrber
(offr.ce Us.)#
NEt{ HATOVER
CqflTY BUILDIITG PERI,IIT
APPLICATIoi,
ryP6: C(HIERCIAL
PTEASE
AlrsttR AtL QUESIIOIS APPLICASLE TO YoUi pmlErT
"Plojqct Rcrponstblltqf
D -rn<, / frv <DATE:tt- t
-fiAP9LIATT'S IIATE I
OEYELO'EI:PtO E
tr
PROIECT ADORESS I/7
ocojpAr{T/8rslirEss trAiE I
CITY:
Zrl:>??A--f
(oo(<A / srht PtfitE
* ?/o-)l?- ?3 4ttI
sr :
ll/ ,( zrP I aSfo I
PR@ERTY
Ot ER'S Mi€:
O {gR'S ADDRESS;3t
A&IH OESIGII PIOFESSIO AL:
EX I'E5I6* PROF€SsRNAI:
DEscRrprroru
or mrx i-f
CO{TNACTOR
A0ORESS 3
,oa= [
acco(trT
t:
EiAIL ADORISS:
PIOiE tt
amle *,70r67i4i?/PROJECT CONI?ACT PERSSI:,, K?
If tPfIT - rhe Sh€lI Pernlt *:Is El€ct lr0llr on this 8uj.1d1ng
dru fino
2,.LrcEEE r: 3l y q
t
cl]iYt adl:v:a sT: y'.c ZrP:
o)dv, >
Exrsr co6T*urr(x:
[t ureurror n.Jffir1i'fi?&L*,- neirns
3 iElocarrpr.
tt
tbcdqr, Eficr€a NaturalGas Lin€ oi rlle Qrrer}r gra? EY6s
Eib lS BLOG SpRttKl-EREDz
I v"" flruo
Ri c rsrftJcrro[:
I rnrcr EH sri[rcrLRE
I rlsr rmcr
I sxrll
f] rrrrr D m ro Exnir srn&TURE
ACCESSoRY STn CnnE:
.."r ts mts A cHn6E oF o<cupalry usr flves
E* ..*'
If Yar, *r.t sJ tha P,.ovloor Occuprnsy Typ.? .- tfitt 15 th. |a* Orcup.ncy
Ttpct
PH:
lrc REG *: _
r,lc RE6
*:Pfi:
5'r-.[.*.?.n/t
bfrodcbo,rrgr}r.pfrdalfindhl*.iu.t.?[ve.Ixo b Th. ProFfy Loo.bd h Ih. Food*t?ves Q No
OISCLAl[ER:that all intomdirn in l,lis all othor applic€b]€ Sl3r€
obns and sE5€tdrs
NC Stat Blds Code and
N6t : odtloslo.r ,lo6tc.t6. &
!.t-b. rrn r.c p..mhecb.ddl.
rt b be
arbmLd lIirt llo.r9lic.to. ft.m (tltfrtS€;rrtE)
rt tE ho acttt of !|tddiI rr b.r|d
b€iain Ad-E d ,lot Yq, ir nqlrrd D ..1 h. t.tlord EllrIoll allyr.d.
t |rr..aoc A& P.lll,lrra 0Eg.tlP) .t (gte1nz<ro .t t.... io
oyr gtc
I rr
drrroa{ori ot.ny baty d boift. 3- iffi W.b Sta:
Srrbi ,
O-nr"
I Tn/(
rOTAL PROJECT COST:
7f.ooo't BUILDING HAGHT:
_ t OF UNTTS:
TOTAL AREA SO FT\2 0 SO FT PER FLR:
IOTAL SQ FT UNDER ROOF:
_ , OF STRUCTURES:
, oF sToRt€s:_
t OF FLOORS:_
ACRES T}ISTURBED:
NEW IMPERVIOUS AREA
Exsr LAlD otsruRsrNc peRunz -ves flHoFT EXISTING IMPERVIOUS AREA:SA FT
PRoPmrgE fpmcE Dnesrarnru,n
w rER McHJA n ma${Ty 8\6TEu
saiwc ffcr+ur flccmm- sernc
I Y\/ELL ElzoMNG rrsE
clrsstEc nont
PFUVAIE
8€mC flml frY 8YEIEX
p rlrEr,rr
tEDrce Elcas{ [o€o( (pAyAEt "E ro
tfic) flerurccoun mrcMBA
fiuscown
r.(
ffFICER:
[t [io,rl
r/l'r
[nnd 3pr(- (rt2
I't
Cill lnpecffi Requrreo, 91
0-254-0?il:
urriz
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)
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Douc[rpr flcoroo onm
Fm ofFcE t €E dat-Y,
tJr
f, Lu
lirill^(;t'- IF\k+.
PEMflTFEE T
X
I
v
SETEA(:(
Ci+)
RECEI\t',:^ Noy
16 2015 k. ls ?b?
2ot?i3tL
APPLICAI,IT'S MllE: Stevens
BuiLdinq ComDanv
T/A Stevens Pj.ne Homes
DEVELOPER:NavaI
PRO]ECT AIDRESS:rTY:
PIONE
f: 910
-794-8699
Wilminoton
BLOCK
*: _ LOT *:
APPLICATION
lllmber
(oFftce Use)
tl
oorr. nlpltot{
ZIP | 2aaoe
Vg
tiT
-f
SUBDIVISIO :
O {ER'S AIDRESS: s?10 oleander Driive suire 200 CITY: wilminoton ST: ng_ ZIP: 28a o3
CONTRACTOR:
srevenE Buildinq Companv LICET{SE f: 31626
ADORESS: 5?10 oleander Drive suite 200
E'ilAIL ADDRESS:c-i -h^1 c^n6cl_alrahcai nah^ma-PIONE
*: qro "ql-
PRoIECT CO{TACT PERSo.{: P}ONE
*: e1o-3j2-8s1s
EXTSTU{G CO STRUCTTON:
I alrrnlrrON
! RercVerrOr
! Crrennl neelrns
! RELocArroN
NEhI CONSTRUCTION:ERECT l{Etrl RESIDENCE
o" ! aOOrrrOn TO EXISTIT{G RESIDENCE
**PLEASE CHECK AND AI{SI{ER EELOOI
ALL THAT APPLY TO YOI'R PRO]ECT:
Arr GARAGE {
11 tr ! orr eaucr
-
sFq0
-l+SFPORCH
lsuHnoor _sF ! emr-
_ sr
u SToRAGE SHED
_ SF
! cnrrunousr
-
sF ! oecr
SF OIHER:5F
TOTAL PROIECT COST 1r-ess ra1 : $ :-zo.ooo# OF STORIES:a
ToTAL HEATED sQ n. 1O1O ToTAL sQ FT U DER RooF. 1b5\ ToTAL AREA
sq rrz 3b51
Is Any ELECTRICAL, Ptt IBII{G or TIECHA!{ICAL rork gej.ng Done to the Accessory
Structure?
[ V", fr ffo
If the project
is a Relocation, is thene a Natural Gas/Line on
the Current Sitel IVes flUo
rs there Electrical Power on
this Building?
l-lves Mfo
PROPERW USE
/ OCCUPAI,ICY:SINGLE FAI4]LY
! ruer-ex
I rowurousr
DESCRIPTIOI{ OF ORK:NpE FF<i dFn1-
a1 Constnrctidn
DISCLAIMER lhereby ceniry tlat a[ inbrmalbn in tlis apphcalion is conect and all work will comply witr fie State
fuitding Code and att oher appticabt€ Sta@
and tocat taws
and ordinances and regulalions. The NHC Developrnenl Services CenEr willbe nolifed ofany changes ln he approved plans andor change in
contfacbr or
contacbr inbrmaton. '"NOTE: Any Work F,erformed WO $e ApplopriaE Pemits witt be in Viotation of the NC State Btdg Subiecl Up To
$500-0e"
OWIIIER/CO TRACTOR:
SIG ATURE :Crei d st evens
**!** ***,i,i,i *,i *,i* **** *** ** * * *(i!Tl JiTl
Exrsrrr{G rrpERvrorrs lutEA. Alo14
NEI{ It{PERvIoIJs AnEA: }A14
*+ ++ ++ +,* *,* **)t *** * )r+*,*,**+ +****,r )*+ ++*,* ***,i )*
* )i* * *
rs rHE pRopERw LocATED rrir a rlooopunr
E vrs El m
SQ FT
SQ FT
TOTAL ACRES DISTURBED: 1/3
I{ATER:
SETER:
EXISr LAr[' DTSTURBTT{G pERrlrT: E VrS
lEl no
crpua
n co {u
rry svsrru
! pRwarE wELL
! crrrul wrll
creua
I cE TRAL
sEprrc
I enrvlrr seerrc
fl cor4r.t rlrry sysrEm
*** SEPARATE PERI4ITS REQUIRED FOR ELECT, ItlECH, PLBG, GAS EqJIP, PREFABS
& INSERTS 'T**
pAyr4Er,rr
irETHoD:
I clsn
I cnrcK (PAYABLE
ro mc1
[ mrnrcar{ ExpREss
E rclwsn E ,rscor.n
,t:f*+:i,t+'t't,t:t++++:t+:i*,**,****,*,**,**+t++:i,i.itr+*:t,t,*r*,***)***:t*:t:i+:i:i:i+:******:t:i,*+++.l,ijt*.t****)r:f:f:*t++ra*
(FOR OFFICE UsE
oriLY) REVISED
DA]E O4l11l12
SETBACKS:
F:_ LH:_ RH:_ B:_
Approval:_ City:_ DATE:_ FLOOo:
_ BFE+2ft=
AVt{
Corment:PERMIT FEE: $llo2Llso
NEW HANOVER COUNTY BUILDING PERIIIT
APPLICATI I rYPr; RESIDEIIITIAL
PLEASE AIIS}IER ALL QIJESTIOIS APPLICABLE TO YOUR PRO]ECT
'ProJect Responsiblliqf
PROPERTY O'[{ER'S Mr,tE: stevens Buildinq Companv PTONE
f:
CITY: -Ur.LeE@_ ST:
Iq ZIP: 28403
zoNE:
_ 0F FICER:
or_,t,- tlts)L5-3294
#
NEW HANOVER COUNTY BUILDING PERMIT
APPLICATI,N rYPE: COIiIMER€IAL
PLEASE AN5H€R ALI QUESTIO}IS APPLICAELE IO YOUR PRO]€CT
"Project ResPorsibillty"
APPLICATION
Nufiber
(offlce us.)
DATE :_L!4_:_:-APPLICANT, S T.NNiE :
DEVELOPER: sA!:s
CITY: !iILM]l''G:ON
OCCUPANT/BUSINESS NAI'IE: Lt,
^.
n. l'1 I r.rc .
PROPERTY OHNERJS NAJ'IE:hI'' .ii: ll: . i.r:i. .l:':'- .::::l iiri:-:-T! '
Oh,NER'S ADORESS: 2C N. 4TH ST. SUITE 213CITY :
CONTRACTOR:.:: LICENSE *:
CITYI WILUINGTON
.1. 1..':r: :'. :::-l ;:.:: rl
PHO E *: 910--']99-'1563
ZIP: :. a i- .-
ADDR ESS: 20 N. 4TH ST. SUITE 213
PlOt{E S: ,'\a- 3i9-'i 563
ST: NC ZIP:28101
ST: N:' ZIP: ,1lJ,: ot
PHONE S:9-t-399-1463
PHONE*: 910-512-9862
EIIIAIL ADORESS:]:r--n curns€rrarmnc. crq
PROJECT CONTACT PERSON:-:.! ., ji i,:
EXr5T COI{STRUCTTON : fl ALTERATTOI{
I{ Rslocdon. is lhere a Nalural Gas Line on the
(ch€(k
AII rh.t APPIY)
RENOVATION 6ENERAL REPAIRS
u RELOCATION
tr
YesNo IS BLDG SPRINKLERED?
u Yes No
NEr{ CON5TRUCTTO{:
fl enrcr ilE}, srRUcruRE
! rrcr rRAcK
n 5HELLuPrrT
D ADD TO EXrsT STRUCTURE
If UPFIT
- The She1l Permit #: Is Etect Power on this Euil'dj'ng E Yes E *O
.'rr.r rs rHrs A cHAirGE oF occuPANcY usrt flvrs [l
fF Yes, hrhat was the Previous Occupancy Typeltlhat ls the t{ew occuPancy TYPe?
Current Site?
Etr
ARCH DESI6ti PROFESSIOML:
ENGR DESIGN PROFESSIONAL:
PH:
PH:
DESCRIPTION OF I,JORK: rinor inaerror ,:enovaLi-ons co extsLinq cf :i-ces
ts tood or bevoragG praparod or 8€n,€d h d{s *r.raue?
[ ves p No b Th6 Ptoperty Located ln The Ftoodcain?
E Yes No
State BurldiogCode and all othor appl,cable StaleDISCIAIIER: I hereby certfy lhal all ,nformalion ir
and local laws and ordinanc€s and requladons. Th€
;i cfran;6 in contoclor or contraclor |-ntormation
"'
Subiedlo Frnes Up To
5500.00"'
rhis aDolkahon rs
correcl and all wott( will comdy wrlh the
NHC beveloomcnt Servicos Center wlllb€ notrlied of any
NOTE. Any Work Psrformed w/O the Appropriate Psrmits
OWNEFICONTRACTOR:SIGNATURE:
htts'.Itviyw. apl.sbb.rE.udcpila6b€sb3/3hmp.hlml
BUILDING HEIGHT: : -'-
"
SG FT PER FLB:
NC REG *:
NC REG #:
and ss
Code and
SQ FI
chathe
,,, . A. it. M.tr: :.
(A/dr, erfl irrr)
Not6: Odlditon fidlLlto.r. &
sbs.!o. dnovc pdmit.pdba xrr a'r tD be ttbohEd [r.ka rh. appltsdoo tu rn (Dltl'S3766)
lvne!.t dE Hlt o. hu&q wa hd b
coit h Arb6b. or not yoo sr! .rqtrksd b coll fle Nls$o;l E nilslon S-t rdard. br HszE dot ! Ar Pdtubnts (NESHAP) at (819)707-5850 8r ha.l t0 day! Fiot b tr.
dedlofibn d rtry h.ffy or hr{dl'lg. S.. A$610! l'r.n Sb:
TOTAL PROJECT COST: ; 9, .10 O . J O
TOTAL AREA SQ FT
# OF UNffS:
# OF STRUCTURES: 1TOTAL SQ FT UNDERROOF: 1 :q2
ACRES OISTURBEO: .'
NEW IMPERVIOUS AREA: i
:154?
EXST LAND DISTURBING PERMIT?
T'] YESNO
SO FT EXISTING IMPERVIOUS AREA:
PRoPERTYUSE:
fprrrce naesnunarr [ueacamu [eorrc nerr n@NDO OTHER:
wATER: TlCFPt A l-"lcor,hruNlTY sYsIEM
EwEIl, IIZONING USE Cl-AllslFEATloN:
-
sEwER: ACFPUA flcer,rmr-semc flp-nvareseprrc EcoMMUNlrYsYsrEM
.. SEPAMTE PERMITS RECUIRED FOR ELECT. MECH. PLBG' 645 EOUIP. PAEFASS & INSERTS -'
'o*t*u Eoscown
(FOROFFrc:US€O LY) REVTEED o lE a''11/12
ZONE OFFICER:SETBACKS: F:-LH:RH:- B:
Appoval:-CitY:-DATE: FLOOD:--BFE+2fl=
tD0N
I
!
Comment PERMIT FEE: $
PRoJECT ADDRESS: :a)8 wR:6Hrs,/1-:,4 AvE\u.
# OF SToRIES:
i-#OFFL@RS:L-
0 or-lB:..:C
NEW HANOVER COT,INTY BUILDING PERMIT
APPLICATIOTI IYPE; COI{HERCIAL
?iaAs: axsr€R Art QU(S'rION5 AP?!iCA3!E TO Yolli PiOlEai
oProJ€ct ReJPorsibiuty"
t5-3294
APPLIfATION
l,lumber
(oPficr Us.)
APPLICANT'5 XA,I4E T urr,lr:rlr':'ix A.i:.r. R DATE:-l:lljllllji:-
PIOi{! E:9r0-399-?563DEVELOP€R: S..!'i!
PRo]:CT ADDREss. -rri,CITY; ;.;: :r,r- )iii'- )\-
OCCUPANT/BU5II{ESS tlAfiE: x. r.. R. !.:
PROPERTY CH €I'S NA'{T IliI:,Y:NG i;]l tn:i LFI'\rIi,lili: U.l
olll ER'5AIDRESS,. 20 !i- 4!!: sr'. iu:Ie ?r3 CITY i ;1:- : :lr':: -- :
ST: l'll ZIP:28{01
CoNTRACT0fi; Y:i,l'lil.-: r
l1J n!.!.s :rai.i:.III::G !11\13T1.Y, I: LJCrXSE ,:
ADDRESS: 20 ::CfTY:'r.1u.t:ltcioli 5T:
!!_ ZIP: 28101
€MATL ADORISS'. -,a,
i' .
a. .. .. r:aa' ri.l
PROJECT CONIACT PERSOI'i PHOt{t
Exrsr colstlucrror:
f, elrealr:on
ll Relocatior, is lhere a Nalu.al Gas Line on lhe
(ctqit Au rh.t AP?ly)
RENova'uoN f-l erllrnll neplrns l--l RELocATToN
enr srre?
Elyes-n No ts aLoc spi;ixLea63'
fl ves fllr'roautt
NEH Cor,rslRucrrol{:
[ :recT {Ew srsucrunE
I rrsr rmcx
f] sHrllurrrr
f] ADD To Exrsr srRUcTURr
If UPFIT
- The she1l Penmit *: Is Elect Pover on :his BuiLding El Yes E rc
,r..r rs rHxs A orAlrgE oF occt pallcY usel
fives El* "*'
If Yes, lhat t4.5 th€ Prwious occirp3ncy TyP.?
--
ttrat i5 the Hei, Oc€upancy type?
-.-*AiCH OESIGII PROFESSIONAL:
E}lcf, DESIGI{ PROFES']O}IALI
DESCRIPTION OT I.jORK:
h 6d or bst srgs pr€9r€d 61 !g1sd h t !& fir.rc1ra?
[v"" [} to b ttre Propsty Locrd h fto Floodcdn?
E ves
[l No
O\IVNER/CONTRACTOR:SIGNATURE:
:., ia,t j.a.rr:.i. r-'.ri1.r:,. 1
'. .
A, A- M.
..."# OF UNITS:
s oF STORIES: )
*OFaLOORS;r -
0if :..::
Oi.t4 lPtt'r'r)
ts D61,d[o,r .lodrcd1are a rs6".br rrrovs p.rfie4p.ffi; b aoa$rnlutC .5kf lhr srolicdon t61n (0H!E'3?8s) ,3i'tur$tt'If -o'lr'*gw 5131d b
.,.i!h ab66 ..,r't yd, dr.!q,i'd b cd t li;;; E nr,5n $r,'dsre ft. Haz*thn Ag' poa1"6 0€s8r4 !t ls19?C?.5S9, d Ld $ d.r! pio.b
ti.
t ,n*iJ J-v aary *AfarrO S* f$mfrrU *, tt@''1"*"'T''€a ic|iLidiltn"et'rt! la
TOTAL PROJECT COST: s9, li:r0,.00 BUILOING HEIGHT:
TOTAL AREA SO FI :
TOTAL SO FIUNDER ROOF: : 1'
ACHES OISTURBED:
p€T LAND DrsruRBtNG PERMIT? FYES ElNo
SQFI EXTSTING IMPERVIOUS AREA:
0
NEW IMPERVIOUS AREA:
Aptrolral:-.
C
OTHER:
WATER:
@
@
CFPUA
CFPUA
tr
-CENTRAL SEPnC
SYSTEM
UWELL
nZONING USE CLASSIFIC*TION:COMMUNII'Y f PRIVATEsEPrc [:]coi,tMUNfrYsYsTEl,SEWER:
". stpARArE pcB'ti!r;stecul]l[o rot{ atEgr- Mrc8. P!BG' GAS EOUIn P',!€lA€s & lNs€qTs "'
PAY$ENT UETHOD:
EcAsH fl cHECI< (eAYABTE To r.nrcl fleuenrcel't exrness
fi ucrusr
ff oscown
...*i*'.{!tdr*.dd.
pnoPERrY t sE: ElorFEe EaEsreuner'n fiurncaml"E E Eouc
[epr ncoxoo
zorc:{)$I"1 OFFICER:r\
N
PEBMTT FEE:0trl{hutk
o-r\Comrnant,i",C{..}Y
, lnipeclsll xequiu{1, v
it}'{ir{'d?u
ZIP;28{ci
PHON! *i 9i0-lr9-7563
Pflotr,E S: 9I0-199-?563
oH! l,lc REG f:
Dr. kc REG S:
SQ FT PER FLR: l-1{2
, oF slRUCrUnE*
iAIgED D T;,ullllz
'l0\
RECE|vED Nov
16 2015 ?E+5NEW HANovER
couNTy BUTLDTNG prnmrr'
APPLICATION
TYPF: RESIDENTIAL
PL€ASE ANS!'lEfi ALt QUESTIONS APPLICABLE
T0 YOIJR PROIECT
"Project Responsibility"
tt337
JZ-
APPLICATION
Number
(offi(e Use)
APPLICANT,S I{AI,1E:
DEVELOPER:
]SL.I. C. dba RamJack
PROIECI ADDRESS: 220 NanLucket Court
SUBDMSIOIII: colony Green PAR1D +R08413-005-024-00O
OTJNER'S ADDRESS: 220 Na:rtuckeL Cour:i
CoNTRACTOR: PS, L.L.c. dba RamJack
cITY: !,litmingron ZIP.. 28412
LOT *: 24
ST: NC ZIP:21r05
PHoNE #: 919-3a9- 9'7 21
BLOCK
f: 2
LICENSE *: s377 B
CITY: Durhar.ADDRESS: 4.122
Bennett Memorial Rd
suil-e 304
EIi,IAIL ADDRESS:
charlie.4 rami ackusa - com
EXISTING CONSTRUCTION:ALTERATIONRENOVATIONGENERAL REPAIRS
NEIJ
coNsrRucrrou:
f| rnrcr rurw
nrsroruce o"
I ADDITION TO EXISTING RESIDENCE
**PLEASE CHECK AND ANSI"IER BELOI, ALL THAT APPLY TO YOUR PRoIECT:
I nrlocarror
SF
SF
ATT GARAGE
-
SF
SUNROOITI
_ SF
GREENHOUSE 5F
DEr GARAGE
_ SF
POOL
_ SF
DECK SF
PORCH
-
SF
STORAGE SHED
OTHER:
TOTAL HEATED SQ FT:
-
TOTAL
5Q FT UNDER ROOF:
-
TOTAL AREA Sq n: ?9o
TOTAL PROIECT COST (Less
Lo0 : $ rrgco.oo S OF SToRIES:
Is Any ELECTRICAL, PLUiIBING
or IIECHANI€AL !,{ork Being Oone to the Accessory Structure?
fl Yes
If the project
is a Relocation,
is there a Natural Gas Line on the Cunrent Site?
[Ves Ilo
Is there Electnical Power
on this Building?I ves
I to
PRoPERTY USE
/ OCCUPANCY rsTNGLE FAMTLv
! ounrrx
fl rounnousr
DESCRIPTIOI'I OF [4,ORK: install heticaf piers ro srabilize foundation
DISCLAIMER lhercby
ce.tjt t|al allinbrmalion in his applicauon is.oEEct and all wori will comply wi1h
he Siale 8{ilding Codc 6nd afl other appticabte Sra€ a.d locar taws
and ordinances and eguldlions. The NHc OeEbpment selvi@s c€.Er wrl b€ notified orany chang€ in he approEd plans and specifi.alions or chang€ in @ntractor or
contacbr iniormarion. "'NOTE: A.yWork P6rlt m€d W/O h€ Apprcpriate Pemlrswil be ln Viotallon of ihe NC
Stab Btdgand Su
I NO
Io $500.00"'
0h,NER/C0NTRACTOR:
charlle LewisSIGNATURE:
(print Nari€)**+**************+**1.****++,****r.*l.{.d.**Iir.**,t*r.,tt***t**rt!i*x*,f*,*+*ir***jtut*,*+++*+*+***+rx,r*r**
r NO
TOTAL ACRES DISTURBED:
rs rHE pRopERTy LocATED rl l rloooplarul
l-l yes
EXISIING IIIPERVIOUS AREA:
_SQ FT
NEW IMPERVIOUS
AREA: _ SQ FT
EXIST LAND DISTURBING pTnuTT: fi Yes
[:] ITo
WATER:CFPUACOIII.IUN]TY SYSTEM
f] nnrvarr wer-r-
f] cENTRAL wELL
SElrlER;creun
I cENTRAL sEprrc
I enrvarr
srerrc
f] coMMUNrry sysrEu
xli, SEPARAT€ pE8llrrs REQUISEO FOR ELECT,
'4ECH,
pLB6, 6A5 fojlp,
PAYT4ENT UETHOD:
[CaSr ICH.CK (payABLE
ro
rxcl I arenrcail axpREss T
5 & rNSsRTs "*1llclvrsA I orscor.*
*{:+ri**,i***,tr:N:t+:}:}+;i:r*+*+)t*)t:})********,t+,}**:tjt:}*:t,}*+*,t+**)t)i*)t+:B*+*****,f *+t,**)*+*?,f
+**+r(:ir},},i
(FON OFFI'E USE OiILY) REVISEO DAIE O4l11l12
ZONE:
_ OF FICER:
Approval:_ City:_ DATE:_ FLOOD:
_
AV
SETBACKS: F: LH: RH: B:
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PHONE #; 91. 9-3a9-912'l
PROPERTY o^lilER'S NArtlE: Martv
! Th-resa Campo PHONE *: 910-612-859?
CITY: viilrniJrq.crr ST:
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PROIECT CoNTACT PERSON: Charrie Lewis PHo E *: 9) 9-3C9-9'7 21