JULY 17 2015 BUILDING APPS-l/i**vrD
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ICATIi}H
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NEhI HANOVER (OUNTY EUXLSIhIG
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OCCI.JFANI/BUSINf55
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wAlEFr: kl_,cF,rrJA I jcoMMUNllYSYsrhy " l:WELL _--[-Jzc]N,NG usH clAsslFics.Tlollr
SEWER: f7-]CFpUA i*ICENTFIAL$EPrlC l--.IrRIVATESEPTIC
[ ]COMMUNI'rY$YS'rHin
FAYMENTMHTHOD:
llJcnsr f,JfirrcrtpAyABLHToNHC) fianarnmnuEXpREs$ ffimr:nrtsa fii":tsct.,vlir
rral{$ra{.t&ff faa$al*aaa*lrlrat*}}}a*}a}t+aalt*.t a*i*r}..4*
(fOR
Off:Ug USE. ONLY) rt*vl'"uD $&rr 4;11/1;
OFFICER: SHTBACKS: F:*-***LH:*"***- Rl"l;**-. B:..*
**
I'r fls('t lrower.
oir rtii i_,:.
lJi]l i11 irir1 1*i l*"1
os occurlANcy
u${I l"l vr,s {$i.l(r *'ii*
..
-.. ilhat :i! l.ht trr,!{ 1)Cr..uFilor
9 i'y,;t:l
l$ ,ood or
bsv€iaget prepared or servsd in this sruclure?
ffi vurs
ff ru,, ts .l'hs Pmpurty
l.orxted lrr Th<r tlrmdgainT
i]l ro,i
lll ru,,
:',irl)t( , I i,, irnr:. i lt) i n
$5!Xl iJO '
TON[::
Approval:*
0rxnm*lnt
?reL rs18d
RECEIVED JUL o1zos
APPLICAIION rYPs; RESIDEI'ITIAL
pLEAss AtlsllEfi ALL sJESIIgils ApPTICABLE TO Y&]E pRolECT
"ProJect f,esPonrlbilfty"
--.tt,tit1:,:/" otTt;6/25/2AL5
ApPLICAilT'$ llAfiE: Scean;Btus ?oclg qnd s,Paa P.f HC, '' "" "' ' ' - -- --r^ffiAFrLrLAilr-' rl',u'!si vu€err;e*Bx lyv?y :-:- -,h: '. ' r
-
plstfi #; g1,0-?gg_]q??.
DEyELgPff,: ocean alue ppols ?nd.Spaa pf It! - ---- ---,-.-*--- "-
3p: 2840si*l*i'otor, -, - lXP:3919:-
;il;;;A;-yp,Joq**. ..,' ''- ' 'Lo(x*i -"*LOT *:
pR#tRTY OftlGR'S llAliE: sereYa Gaqs$a*-., ,, ," " ""' " Pll0l{g *: 910*6'22*5330 '
CI6{ER,s roDftEss: ezn *.rui}. outf l"tvT - iirvi-wirryllgt'en " '' ' 5T:39-zrP:3*l3i*
CoirTRlCTOn: opean,Bluq,,,,9oo*.8 qJtd
$paB,or N9 ' LICE{5E fr 73?60 '
HEhr HAH',ER cour{ry surLDrH. psRr,rrr t0l5-
(lltl t
APPLI(ATIU'I
ltumbe r
(offtct Us*)
AODTESS: 30,,cov*1 Aq€nue ,, -. ".---_ CITY:
ll*$!:!gggg
EfiAIL ADORESS:
pnOlECT C0{IITACT PERSOII: Na*cv garlsqn ,, - ' "' '"' "' " ' P}g{E *l 910:r99;it?:
ExrsTlire Coilsr1u(rloil:
I ALTERATI9I'I
ft nrnovlrron
fJ eruet61. REPAIR5
f] nrr'ocarrOn
r{El{ CotrlSTRtKTIott: f] rxrCr ilEu f,ESIDEHCE or
E aonrrrOx To ExlsTXltlc ReSIDfl{CE
**pLEASf CIiECX AtlO Af{sl{f[ 8fl0t'l ALt THAT arptY TO Yfl}B PROIGCT:
f]*rr GAIAGI
-
5F
fJ ner GAxAGt 5r
flpoor.
-
5F
fi recr
. ,,, ,, , srflsuilaoon
-sF
f] erreruousc
-
sF
TOTAL HEAlfo 9Q FT:TOTAL 5Q rT ui[DER BOOF:TOTAL AREA 5Q FT:
T0TAL PROlfcT Co3Ttlcsslo : $,re',eoo * Of STORIES:
IsAnyELECTfiICAL,PLutiBII{GorllEcttAltICALl.lorkBeingDonetothaAc(ess0ry
IftheproJectisaRelocatlonrlsthereaNaturalGasLlneonthe
rs thcre Electrlcal Power on this Suildlng?Jflves *No
pnopEnw vs|
I occuPAllcY:
[i srucr-r FAHTLY
f] oullex
f] rommuse
rhwLt.r i er- , '--
pHo{r
sr: Ig- zIPr
!ft1!!
#: c10-?99-3022
f]roncn
-sF
fl sron*er silrD
-
sF
OTHER: in*qround sPa 63 SF
structlrt?
$! ves
fi N"
currsnt sj.te?
flves tl *o
isd-^errstrhq
W rr;fuch t1 I
t
ffiffi'' ffi nffi;'fr f ,ilfr
,ii;;"l'i'6';;; c** -is:-:if Y :l?1tr:1y3''trK1i
ad ae o**r applh€blo stsb &rd bcd lsr'$
ip€ciicafon{
ffiIlffiffiKffi, ff ffi,6ffi;i/r;;^"prr# ne'mit$w*r !a in vctadon ortre Nc sret BrdI
I
ohreER/cslrnAcroR: P,g^-]t^q-. Dq'Qlq SrGl{ArurEr
*,r*{.,r**rf{c*******r*,},r*,*****(I!tllJ$t}*****:t *r,**rr*1.*,r********r(**
I9 ITIE PROPERTY LOCATEO IH A FLO@PLTIIII
ffi VES ffi TO
EXISTII{G IllpEnYIflrS Anel:
..X,{X?' SQ rT
r{Eu rl,lpERvxou$ AftEAr *-t,s* ,5q rT
in conF€cDr or
ra :*
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ft comtuNrry sysrEr,r
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f] rnrvrru sEPrrc
fi cottnuN:rY sYsreil
s*4 Sfrp<&Tt **ftftxfiL *#s.{,}xmr* v*n hjfi{"r, $*t$r ?Lga,6A5 €#JIpr P',t[FA&S & Ifrs{*r$ ***
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(rot orFr(6 Usr oltY) isvrSED oaTt ultrllT
Approval:-Clty:- DATE:- FL00D: -,- -f ...,- BFE+2ft*
#
TOTAL ACRTS OISTUNBTD:
TXI'T LA}D DISTUNBXI$
Tr
J$00.00'"'
I KZ /s_ /7zYSs _lq,il?. NEW HANOVER COUNTY
BUILDING PERMTT
dt applrcArro rrpE; RESIDENTIAL
*n# PLEAsE AirsrJER
ar-t QuEsrrors AppLrcaBLE
ro youR
pRolECr APPLICATIO{
Hg ,-\ / ,;'?"o|ect R€s pons
lbil
it!/' Number
- . / 1 ./ ,// -.--^ '^ ' ((xri(c use)
AppLrcAN,s n^,rE: ,/1 FDK r /_2--<_
pRorEcr ADDRE5S t .,tb3 PK)[{E
l: 274 3{}A
su'Drvrsroir: -7-To,-o.r- ' .aafur, _,
ztP:
2?'/a)
Tfl::y^H::.s wte, pK)rE
r: ?1o6/2 ?,.,otntER's ADDRESS t ,- / ,93t1 t.2ci.fzr+,,.ru"
.c
cttw ,/ ,zr
-..- ,r rffir'-a
-.IIf'o*, i( :f- ,;"+ , LTCENE
*: 3-) t,-
d
DEVELOPER:
PROPERTY USE
/
DESCRIPTIOI{ OF
DATE:
PHONE
I:
'J 4a.<,na,.a
s
ADDRESS:
/ o .a
e:-1 .:Fg'o4 _ .. - -cttv: a,G- st4ztp: 2E,to.
E AIL ADDRESS: (' ;'Fb+f 4_Q @ Ji-t^-.,'t . t_:^ --iffi *, Zyo
cjT iSsS
PRO]ECT COiITACT PEnSON:(</ ^o,<=)-,
ExrsrrNc co{srRucrroN:
fftteaanon @<fi,,-ovnrror
! erHenar- *roorr,
! *,ro,orrli
r{EH Cot{srnucrror:
! rnrcr NEU nESIDENCE
o" fleDDttroN ro Exrsrr{G REsIOEt{cE
i.pLEAsE cHE€r( ailD ailswER gElolir aLL
'HAT
apply ro youR
pRoJEcr: Qr^4c- [,s], e.r<
! arr eruee
-
sF ! oer ernaer ----sF
! roncx
-
sF ti e R ,< b0 fsq
Isurunoom
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3 r*.- --lI irro*ouG-"' ., krkr^e., Af.ga-
_ sF futkte., AASa-f] cnre r.uousr
_ sF
! orcr
-
sr orHER:
_ sF /:czvr -.r9 t(s.,/,-
TOTAT HEATED SQ FT:TOTAT SQ FT UlrtDER
ROOF:-5F2 TOTAL AREA SQ FT:
ToTAt PROJECT COST lress rorl
: $ 25b a t>c *OF STORIES: Z
#
rs Anv ELEcrRrcAL, pLUilBr{G or ttEcHA{rcat work Being Done
to the accessory stru(ture?
fl v"s I Horf the project
is a Rerocation,
is there a Natural Gas Line on the current
sit"l Ivf, I roIs there Electrical Power on
this Buitding?[ve, Ito
0CCUPAtTtCY:
sTNGLE FAMTLy
fl ourlex
fl rowrxousr
hroR(:/.r|-E
,Jt7"t
[,lsul.Al tt{ I hecDv cenry D.r.t mbrmalion in
his applicaljon b c6necr and
e wo*wil complyveih tle Srare Su,U,ng Coor
a6,[fl[[fffiffi1f;ffiffi
:::,:jfflT:":,'":1'.::,T*'*.Y":,T.::g:T"*T:"'-:.1:1":""'-"1:ltj,:1-f :l"is*.1,,"".."rp:*a pr"'".""0
'p.",t",,ioi" li"i"nn",
"o"n""",o,contracbr iDbmaion. ".lloTE: Any work pedom€d wo be Approprists peflnirs wi be in
viotsr _r!!'!@'lurri ur Lr.nse
r con(acbt I
_/.>, ion ot rhe N C
Sr.E Btdg Code
,rd SrllEt b Fines t p To
i500.0o...
ohlNER/coNTRAcT o* B- Jf?/z^/?/'r-.- ,'n o-n sffitaunt t
***,* **:r**** **+*** **
*** **** Jl!'fl,l?TJ * **
*****r* **:r* *** r *:r*,ira *r* *,..+**
DISCLAIUER: I heaby certify h.r.l anbrmarion
in-his appticarjon
b
zoNE:
_ 0F FICER:
approval:_ city:
rs rHE pRopERTy rocATED
r{ a FrooDpLArN?
n yEs E rro
EXISTI]{G IIIPERVId,S AREA:
-sQ
FT ToTAL AcREs DISTURBED:
ttEhr
rr'lPJRvrous aREA:
_'- 5Q FT Exrsr LA]{D DrsruRBrrc prnnrrt l_.l yrs l-l uo,/
blArER I
E lpu^ fl cor'ruutrw svsre r.r
I pRrvarE wELL
f] ce urnal wrr-r_
sEt{ER:
-[zl crcua
I CENTRAT
sEprrc
I enrvare
srerrc
I coMMuNrry sysrEr{
i" SFPARATE PERtilrIs REQUTFED roR Ei-Ecr, ilEcH, pr-BG, GAs EQUrp, pRtraBs I rNsER.rs ,,r
payrE
T ErHoD:
Icosx
f] crecK (payABr.E
ro *rc
1
[nne*1.- ,io*ri, Eni^iio" 'Err.orr*
* *i * *+* *+a* **+* +*tl* *** *r*** I **+ **r* **t| *
+**:i ***:l **'t ***:, *t *t ***:t*:t *:****,***t******:t:t**:i **** *i*
(Foi offrcE usE
otY)
SETBACKS:
F: LH: RH:
-
B:
fl
PTIIIIT
iEvtsED DATE
Oal11/12
BFE+2ft=
C4,
conm€nt:
DATE:_ FLOoD:
FEE:
'
NEW
aot5-0,75t
HA}IOVER COUNTY BUILDING PERMIT 15 - 18 O 3
Appl,rcAtroN rypE:
J'^-EE!f, C0fnrnCfg,A I
ApplrcArroN
*" *T#
""TJ'il'#"l ffi,; ru* PR, rcr
i -ri=rc,t\.r<-Y i\ 9.Lr . \ fi i
Nunber
(Office Use)
APPLIOAAIT S M&E
DEVELOPER:
PROJECT ADDRESS:
'Lo'Lto {-tr,+ &fir'fr- -rrPt t CTTY:
SUBDT\IISION:
PFtrFERTY OfiER S IlaI'IS:
O/UER S aonRrss:
DArE: '*1 I Llr {
zrP: L.jr-I0.5
PHo$IE
#: 3t-&:-f32,.:-S>ci4
CITY: ST: q5. ZtP:', "J
r>i
LIcENSE *,
.,-Li^W-
PHCD{E
*:
Lt. \rrr, r ,rJ h n
BIOCK #: IOT #:
CCIITTRACTOR:
xUlgSl{t_ t}a[ -\fre CITY:j%
PHOI{E
sT:{lL zIPt 2*4tl
*: dltu- 5d;--qc,ri
pRoJEC? COIITACT pERSCDi: Mlrlfrr
$0l/\ckl|r\&\., PHCX{E
+: qlu - E^13- tS'1
ExrsrrNc coNsrRUCTron:
! ALTERATToN
ffi-rlovarroN fJemuner, REpArRs
ft nnrccntroN
I sunmra- sF
fJcnermHousE- sr
NEwtrhrsrRlrnchi
fJ ERE(r }€wREsrDErtIx
or flADnrrcN To E)(Sn}.{3 REsrrE}tr
i*PLEASE CTECK AD I[\6\IER BEI,CIWALL
TI{AT APPLY TO }IT-R. PROIECT:
ATT GARAGE SF
I orr G,.RAGsr [l PoRCH sF
n n*"
flcro<
rorAr. TEATED SQ FT:
1L:l TOrAL SQ FT {I\EER RffF: cr'l{ TOrAL AREA SQ FT:
33j;
TUIAL PRCtrECT ffiTrrcssr-o; $ 3(,r,?,S.tZ# CF STCRIES:
Is Any ELECTRfCAL, PLUMBING or MEC!{ANICAL WoTk
Bei,ng Done
to the Accessory Structuret ffi"t fJ *"
If the project
is a Relocation, is there a l*tural Gs Line on the Orrrent Site?
flV"r f|ib
Is there Electrical Powr on this Brilding? ftV", d*
pRopERry usE
/ o@upAr.ICy:
I srr'rcra FAMrry
fl *ro pf6cn$iurousn
DESCRIPTION OF $IORK:
6f P r\r'r,r, rr
$
- /(.ixrzo*r^trr
DISCLAIMER I herBby csnify llat aI infomatbn in his apdicaton b conect and d wdk wiH comply with he Sia!6 B.rilding Code 'ld d oher ryplic*b Stab and krcal lsws
ad ordinancos std r€gulEtons. Tho NHC Dovelopmeot Sorvices Cenbr will be notfied otany ch$ges in
fio eproved plans
ild speciflcafoni ot changc in contrecttt or
contractor inbrmaton. '"'lilOTE: Any Wbrk Pariormed w/O lhe Appropriab Penfiits will b6 in Vblation of the NC
StaE Edg Cod€ d|d Subjccl b Fines Up To
$500.0S"
OWNER/CONTRACTOR:SIGdATUBE:
{Print Nar.e)
* * * * *** *
*** * * ** ** *
r.* ** ir* ** ***J. *** ** * ** * ** * *** ** *
*** * * * * * * ** * ** *** *** ** * ** * * * ** * * * * *r.* * * *
rs Tttr PRCPERTY r..trAIED IN A FI-Gf,PL-AIr',p
Ef VsS
EXISTING IMPERVIOUS AREA:
-
SQ m
NEI,{ IMPERVIOUS AREA: SQ FT
TC'I"AL A(NES NSTI.RBED
E)(ST LAI\D TTSTIRBI}€ PERMT
[f VTS
EI rc
wATER:
I creua
fJ com'rinirw sysrnM
f] enrvern wm,l
I cxrvrnel wu,
sErER:
ft creue
f] cnsmar, sEPrrc
fl enrvate sEPrrc
fl comanuY sYSrEr4
tl.*" ficrr.n (eA,ABLE
ro NHc) flen,emclnlEIoRESS Irclraso fiusm,rnPAYMEI{T METHOD: T*
***************l************************************************************************
ZONE:
-
OFFICER:
(FOR crFrCE U.sE o!Lv) RE1,l
SED mTE 04/ I ll l2
SETBACI(S: F:- 1,H:- RH:- B:-
Approval:- CitY:- DATE:- FIOOD:BFE+2ft:
-
VN
JISTORAGE SHED D.E
STSF OI}IER:
L
NC
A
Corment:PERMIT EEE: $.
ADDRESS: A?
E}4AIL ADDRESS:
01?!*
APPLTCAfiTJS IIATE:
DEVELC}PER:
NEU HAilOVER COUNTY
BUILDIIIG PERTqTT
APPLIC,.TIaN
rr?E: C(ItlllERCIAL
PLEASE attls|rER
ALt CISSTIOTE AppLlCAELt TO W{rfi pBOlB(r
"projert Respons
iblltt5f
riei-Sq!"
P}PNE
#;
PROIECT ADDRESS: a017 Lake Shore Drive-Aot. G
CJTY: Ei.tmioqcon
OCCUPAXT/BIrSIfi
ESS I'lAllE : ospre), Landins .rrpartmenrs
PROFERTY
OtFlER'S
}rlAllE: Osprey Landiqg Apnrtne.tsl-S, Surith- contacE PI{OIIE
OI{NER'S A0DRESSI ).6C? eueens st.
clw: leilaioqtgn
(0MRACTOR: ltaaJack LICENSE [: s3?78
ADDRESS: 4122
Bennelb Merorial Rd- Sr,e. 304
CITY: Durham
EllAIt ADDRESS: denisegrami ackusa. conr
ZIP :.2 B.1o +"_
*: e"lp-.4.9e.;-8?82-
5T:
& Zf?: 28403
5T:gg_ zrP: 2??os.
PlOl{E
*: .9*9:309.-9727 _
PhOilE
*: 9l9-3a9-9i21PROJECT COilTACT
PEt50fi: oenise s1'kes
Exrsr co*srnU(rrox:
ft nrrenmror
n *rJil;iii'lh?!'il*. REpArRs
fl neroarror*
rR.localidr, is therea Narual
cas Line on the cuner(
Srez
flvI-flruo ls BLDG spR:ilKLEREDT
f] ves
f]No
tirEl'l coHsrRucrroil:
f] EREcr t{Ett
srRucrunE
f] rlsr rnAcx
fJ sHELL
il uprrr
[l ADo
ro Exrsr srlrrcruRE
ACCESSORY STRU{TURE:
If UPFIT
- The Shell Penmit tr:
IrE rs THIS
A CHAI,IGE
fF Yes,
Hiat Bas
the Prwiotrs occupancy Typel
ARCH DESIGN
PROFESSIOML:
ErXn DESfGil PROFESSIO{AL: Janes
sutton
Is Elect Pouer
on this Building fi ves il HO
0F OGCUPAIICY
Usg?
IYES [-lno ...'*
t&at is the lley Oc.uprney Type?
PH:.".,-..--.- NC REG #:
PH:9le-$.rl:-1{tfl0 NC REG *: 036844
DESCRIPTION
OF !,IORK: rftsta:!r 6 belicaL pile$ to stabilize foqldation. No change
!o footorint.
Bnood r bareraguo prep*od q seryad h tlc srLrrre?
[vu" fiJffo b The propody I ocded tn
Tho Floodfldn?
f] vu"
fi r.ro
rysa^Igl: I hs6by csrli{y ttal. all intsmalim in
lhis-applir:diql is corrr,r ild a[ wofk will
canf,y wirh tu sur6 Buiding code arid all
ollE ap,glicabl€
sr,rre
tr ffi.ffi 1e.il8?ffiffi?83trffi ffiTi*oE#*90,"j,fl&tffiEffi,trEtsfy,ffi fiEt8B strffiH;6ubJ6.ctlo Fines tlp To tSfXl (E-'
OWNEPCS{TBACTOR: -ta+oecl./ Richard sy.kesSIG}.IATURE:
lor*{ otilrtD)f&rEDatddlrrficds&rebettusrl{rordp{rfTtHurl|bt albfitrldr-{fr.pdcdglftnn{O+Jfg-fZOf)rtdratrctc*yctrl*gEbrdb
lOrS{0
q*tArb*rr!dLYorrrt!{irldbc.0rrH{m.lEnill*rt SErdudrb'{!eer*nocrrpC*ffl retei7trr-se60*tn.,'taaq|3Fr;r&.de.ml6 d ." f.py c b.I&rg! SE A.rra Ul.!
e H{Frrffiad.e.rBr5ed,Sae./*E p,tnrt
TOTALPRoJECTCOST: s5, ?.:IJ.09
_ BUilOtNGHE|GHT:*OFUNITS:
TOTALANEASQ
FT:SQFT PER FLR:
sOFSTQRIES:
TOfAl SQ FT UNDER
R9OF:
--
ACRESDIfiURBED:_
NE\,V IUFERVIO{JS AREIU
SOFFLOOB*
E(Sr LAr.rO DTSTURBTNG pERMn?
il yrs fl No
SQFT E(ISTINGIMP€RVIOt.ISIAREA
SOFSTRTJCTUBES:
SQFI'
pRopERTyuse flomcr [nrsrrunnxr flrrrmcnnrue
[rouc [JePr fJmxoo ofiER
wArry @cFprJA [conMuNrrvs\6trE!!_ nwELL IzoNlNGUsECtisstFtcATroN:
SEWER: MCFPTIA
fi CCTTAEI-SEPTIC IJPRMATESEPTIC [COUMU[.rrrVS\4STEM
-'$FPiii;1i:;raQililiJ;F:fl,lit'.it[r!r:i'rai$ii-itr;3.:aA"ql..a!.]r;:i:iii:iiia{L[il'ii:::,.
PAYlrENrhtETt{oo ncAst{ flcueo<lneveaLETo}&rc) f,]nrenrcexExnREss
ffucrurse florscovea
ffiffiffi*ffi}.*iffiffia
ZOXEM-$ (y:Fr)EI<I gJ(FOf,OFFCEISE0ItY)I , t / REvNEDuATE/ulnz
_ SEIBACKS;
r: #r._
t-n:
{ RH; 14 B:_5_Appr,oml Ciry: IJlfii- DATef
ao6-tp'|5U
W7- 15-\ Slt
APPLICATIOfl
tlunber
(Ofri.ce UtG)
plft; ?/1,i1s
CommBfit
FLooD:---_.-_- ii BFE+2ft=Av/\
,ffi-
NEhJ
HA]WVER COUNTY BUILDING PERI{IT
APPLTCA|
I@I TYPE.' COI''ITLIERCIAL
PLEASE ANSI.IER
AII- QUESTIO}TS APPLICABLE TO YOUR PRO]EC]
"Project Responsibility"
}{AllE : Solst ice Bui lders LLC
PROIECT ADDRESS: 2oo
willard srreerCITY: t.lilminqEon
0CCUPANT/BUSINESS
torllE:
rhe Arr work€
APPLICA'{T'S
DEVELOPER:
&
PROPERTY
OI'{ER' S
O {ER'S ADORESS:
Coi{TMCToR:
soLscice Eli1ders, LLc
ADORESS: po Box 11459
EtiOIL AIDRESS: mi.chelle@Eol licglqilders.com
}{AllE: Ber.6y & Jim knowles
LICEIiISE *: 50024
CITY: souchoor--
9!0-352-7822
zr.P I
ST: NC ZfP: 28461
*i 9ta- 4s4 -9a22
*: 91c-g9o- 9310
CTTY:
PROIECT COI'ITACT PERSON:
srer Norburv
PI{oNE
PIONE
Exrsr cor{srRucrrori:
E aLrERArror{
fl -rJiIi!;li 'ET.lil*o. REpArRs
T'l RELocArro
lf
Rdocation, istherea NarurarGas Line on the 6-unent
sitez
IveiEto rsBLDGspfii KLERED?
flv". Elto
NEhl
cotisrRucrroil:
I enscr E srRucruRe
I rasr rnacr
I sarr-r-
[ urrrr
[] noo ro Exrsr srRUcruRE
ACCESSORY STRUCTURE: ADA
accessible handrai.ls on
exrerior of Lu]ldinq
If UPFIT
- The
Shell Pernit *:
Is Ele€t Power
on this Buildint f] yes EI mo
oF ocGrPA
cY usE? flYEs
occupancy Type?t{hat
is
NC REG *:
NC REG *:
DESCRIPTIOII OF IIORK: ADA
compliant
handrail and code baLlisrerE Eo exisrino ramp
srructu:.e
ls food or bonmgea prepasd or
seved h trla errnrcl
[ve. [lNo r n" eropety LocEtad tn
TiF Fhodptaln?
[ ves
[ ruo
DISC|AIMER: I herebv certifY thal all informalion in this applEatim is
co ect and sl, wofk wil
cofidy wittl t]E State Building Code and alt other applicsble Stateand.localla./s and ordinances and regulations. The HHq-b'evetopmeni
servtdsGirii rrrttoe norit& a anv
ciri'iie iiiiiiE
i Jii# t*ans ana soec;ncarions
$,flSff iltrJ["r"+g S&:t[aSor iirormation. *NorE: AnyWort Fririormis
W]oiirJfuEop-riii!-pi',niC;liiie;iV;i$$-ffibi tIE fiEEriiSdffi"iEtilio
SIGNATURE:
# OF UNITS:
# OF STORIES: r.
# OF FLOORS:
EXST LAND DISTURBING
PERMI?
D YES
EI NO
SOFT E(STING IMPERVIOUS AREA: 0
PRoPERTY
usE: floFrEE nnesreunarr
[urrcernue
I eouc
f]apr Ecoxoo orHER
a.s_set-r.",.,_
!vjIE!: mgryuA EooMMUNITYSYSTEM flwELL EzoNtitcusEc[esstFtcAloN:
SEVVER:
fl CFpUA fICENTML SEpTrc flpR-rvATE SEprlc EarMUNry S\6TEM
PAYMENTMETH@: flCaSx f]cxecxpnvrelEroNHc) flamenrcaNexeREss E]Mc /tsA
Ioscoven
(FOR OFFTCE USE ONL'FE1ITED DA1E {/1 I/I2ZONE:_OFFICER:SETBACKS:
F:-LH: RH:- B:-Apprcval:_ CiV:_DATE_ FLOOD:__ _ BFE+2tu
AVN
r*r.r rs Tt{rs a cltaltcE
Has the Prevlous Occupancy fype?
[]rc
the t{flIF Yes, rihat
AR(}I D€SIOI
EI{GR D€SIG1I
PROFESS'OIAL:
PROFESSIONAL:
PH:
PH:
(Ar.Iln (hrnkr)
t'lot9:
D.fidBon ndrcrdon!
t 8!b.6!oo rinord p6amh.ppticdo.E a" to ba $srnhrd ullng tE spCtcrt(,l fo.m (DHHs-376s)
rhlelc $e
f.d[t d hdHtE wls lblrd to
cor{ah A8bac6 o. nd You
d!
'eqrr6d
!o
c.fi tr6 sddd E Saslorl S-t rd.rds
ltr H@rdoJr Ar PdhMs 6eS*f1a ptgircz*eOO at hssr 10d!y5 Fto. to rh.dqid[hn o, {ly tld$ty o. b!{dn!.
56 Albaaos W€b
slb: i,ilpr' .,'*!A.epi.s€je rc ,]s]eat€sbeslos,ahmp hirrl
OWNEFyCONTMCTOR:
crittora K pender
TOTAL PROJECT
COST: 24,4s2.1s BUILDING HEIGHT:
TOTALAREASQ FT :4]2.5 SQ FT PER FLR:
TOTAL
SA FT UNDER ROOF:
NA f oF STRUCTURES:
ACRES DISTURBED: N.I.
NEW IMPERVIOUS AREA: o SO FT
aot5- (p'151
1s-L832
APPIICATIOT{
llumber
(Office Use)
DATE! 6 / 6
/201,5
#: %:383:2.932-
ZIP
i 28407
P}P E *:
ST:
Comm€nt pERM;TFEE:$.
AatS-tu-?@
NEt^l HANOVER COUNTY BUILDING PERMIT
APPLICATIaN TYPE: COMMERCfAL
PLEASE ANSI./ER ALL QUESTIONS APPLICABLE TO YOUR PRO]ECT
"Project Responsibility"
Egan Realtv Services - Aqent for Verizon Wireless
APPLICATION
Number
(of+ice Use)
DATE: 1/1/15APPLICANT'S NA}IE:
DEVE LOPER:PHONE #:
PROIECT ADDRESS:
4502 park Avenue
OCCUPANT/BUSINESS NA}TE :
CITY: wi tminqron, NCZIP | 28aa3
PROPERTY OWNER,S
OWNER'S ADDRESS:
NA,4E: Rettv r. siarbuck PHONE f:
CITY: wriqhtsvl Lle sT :
J!_ zIP ::jl!!_
ST :
l!_ ZIP:ji688
CONTRACTOR: : e t,
a.: o:l LICENSE #: lc5rs-u ACCOUNT #:
CITY: tampa
EMIL ADDRESS:
PROJECT CONTACT PERSON: r],-ni:i- \'lier
PHONE #:
PHONE f:
(check
AII rhat Apply)
EXrST CONSTRUCTTON:
! ALTERATTON
! neHOVlrrOru E.g5rue*or- REPATRS
E RELOCATTON
ll Relocation. is lhere a Nalural cas Lineonthe Cwrent
Sitez
IVes Ilo ts gf oc spRlNxlgneOz
I ves
[ruo
NEti coNsTRUcTror:
! rRecr NEh, STRUCTURE
!rasr TRACK
E SHELLEurrrrIADD ro Exrsr srRUcruRE
ACCESSORY STRUCTURE:
If UPFIT The Shell Permit #:
****r( Is THIS A CHA GE
IF Yes, what was the Previous Occupancy Type?Occupancy Type?
ARCH DESIGN PROFESSIOML:
ENGR DESIGN PROFESSIOML:
DESCRIPTION OF WORK:
Kimley - Horn
KimLev
- Horn
PHi..18-a33-392A NC REG *: 041r45
PH:
6lB-533-3928 NC REG #: 041r45
(Oulifer) (Pd Nalrp)
contain A3b€stos or not. You are required to call the National Emission Standards tror Hazardous Air Pollutanb (NESHAP) at (919)707-5950 at least 10 days prior to th€
demolitjon of sny facility or building. See Asbesios Web Sile: http:/ dww.epi.siate.nc.us/epi/arbesto6/ahmp.hhl
ls food or beverages prepared or served in this struaure?
[ves fi uo ls The Property Located ln The FloodplainZ
I ves
I lo
DISCLAIMER: I hereby certify that all information in this application is correct and all work will comply with the State Building Code and all other applicable State
and local laws and ordinances and reoulations The NHC Develoomenl Services Cenler will be notilied of anv chanoes in the aooroved olans and sDecrlications
or chanqe in
contraclor or conlraclor i-nformation.
"'NOTE: Any Wo.k Performed w/O the Appropriaie Permils will 6e in Vrolati6n ol lhe'NC Slale Bldg Code and
Subjectlo Fines Up To
$500.00"'
OWNER/CONTRACTOR: oenise vliet aqent for verlzon SIGNATURE:
TOTAL PROJECT
COST: 15,CCC,Ot,] BUILDING HEIGHT:# OF UNITS:
TOTAL AREA SQ FT:- SQFTPERFLR:
TOTAL SO FT UNDER ROOF:
ACRES DISTURBED:
# OF STRUCTURES:
NEW IMPERVIOUS AREA:SO FT EXISTING IMPERVIOUS AREA:SQ FT
EXST LAND DISTURBING PERMIT?
NYES N NO
pRopERryusE: florrrce E]Resmunnrur luencarurrLE leouc lner lconoo orHER:
WATER: ECFPUA ECOMMUNIry SYSTEM
EWELL IZONING USE CLASSIFICATION:
SEWER:
E CFPUA ECENTRAL SEPTIC Ll PRIVATE SEPTIC E COMMUNITY SYSTEM
*, SEPARATE PERI\IITS REOUIRED FOR ELECT, II,lECH, PLBG, GAS EOUIP, PREFABS & INSERTS *'
ZONE:OFFICER:SETBACKS: F:-LH:- RH:- B:
DATE:- FLOOD:
-- -
BFE+2ft=
PAYMENT METHOD: ECASH [CneCr leeVmLE TO NHC)
[erU ACCOUUT [UCnflSe I OTSCOVeR
(FOR OFFTCE USE ONLY)
# OF STORIES:
# OF FLOORS:
ADDroval: Citv:
Comment
N
PERMIT FEE: $
Is Elect Power on this Building E Yes E ruo
oF occuPANcY use r
fl vrs [ rc
tJhat is the ilew
REVISED DATE 4/11/12
)06- b?+c
NEW HANOVER COUNTY BUILDING PERMIT
APPLICATION TYPE
: RESIDENTIAL
PLEASE ANSWER ALL QUESTIONS APPLICABLE TO YOUR PRO]ECT
"Project Responsibility"
Charter Buildinq Group
PROIECT ADDRESS: 8578 Gar-roway Natlonal Dr
CITY: wilminston
SUBDIVISION: Porters Neck Pfantation - Edgewood
APPLICATION
Number
(Office Use)
DATE: '7/6itsAPPLICANT,S I.IIIIIIE :
DEVELOPER:
PROPERTY OhINER'S TIAI{E
:
OI{NER'S ATDRESS:
Greq and Tammv Kell
BLOCK #: _ LOT f:
PHONE
#:
PHONE #z 9Lo-j69-2440
ZTPz 2s47r
PHONE
PHONE
ST:_ZTPz_
ST:qZIP| ry
#: gro-r 69-2440
CONTRACTOR: Charter Buitdinq Group
ADDRESS: 108
Gifes Ave., suite 104
EII'IAIL ADDRESS
! kirstenGcharterbuildinqqroup . com
CITY:
LICENSE *. 61 61 9
CITY: wifminston
PROIECT CONTACT PERSON: Sean Lewis#:
SF
! sronacE sHED
SF OTHER:
-SF
SF
ExrsrrNc coNsrRucrron:
f] ALTERATToN
! nrruovarroru
f]crrurnnl REPATRS
I nelocnrror't
NEI'I CoNSTRUCTTON:
I eneCr NEW RESTDENCE or f] AOOTTTON TO EXTSTTNG RESTDENCE
**PLEASE CHECK AND ANSWER BELOhI ALL THAT APPLY TO YOUR PRO]ECT:
Elnrr GARAGE s8o sF
E oer GARAGEsF
E PoRcH 4e2 sF
lsurunoou _sF! eoor-
! cneeruHouse SF
! orcr
TOTAL HEATED SQ FTi
2s2i TOTAL
SQ FT UNDER ROOF: 3ele TOTAL AREA
SQ FT: :qag
TOTAL PROIECT CoST(ressloq ! $ tqo,ssa # OF STORIES: z
Is Any ELECTRICAL, PLUI{BING or MECHAITIICAL Work Being Done to the Accessory Stnucture?
fl Ves E ruo
If the pnoject
is a Relocation, is thene a Natunal Gas Line on the Current Site? [ v"t il ruo
Is there Electrical Power on this Building?
l]]ves E ,o
pRopERTy usE
/ occupANCy:
@ srrucr-r FAMTLY
! ouer-rx
! rowruHousr
DESCRIPTION OF WORK: New Sinsle Family dweJ-1ing with attached garage
and ordinances and regulations. The NHC Development Services Center will be notified
of any changes in
he approved plans and specifications or change in
contractor or
confactor information. .".NOTE:AnyWork Performed W/O
freAppropriate Permitswillbe in Violation of the NC StaE Bldg Code and Subject tc Fines Up To
$500.00'..
OWNER/CONTRACTOR:
charrer Buitdinq GroupSIGNATURE:
(Print Name)********r.*)*)r*{<i(*,tr***r.xr(r(r.x:tr(**r(****{.************************r(*************i(**xx****,k****
IS THE PROPERTY LOCATED IN A FLOODPLAIN?
JI YES IEI ruO
EXISTING IMPERVIOUS AREA: O
sQ FT
TOTAL ACRES DISTURBED: <I/3
NEW ImPERVIOUS AREA: 523e SQ FTEXIST LAND DISTURBING PERMIT:
J]] VTS
II] NO
hrATER,
I creun
! comNurrrrry iysrEM
I enrvare wrll I crrurnnL lntELL
sEr.tER:
@ crnun
! crrurnnl sEprrc
I enrvarE sEprrc
E commur,rrry sysrEM
{.,I.* SEPARATE PERMITS REQUIRED FOR ELECT, MECH, PLBG, GAs EQUIP, PREFABS & INSERTS ***
PAYMENT IiIETHOD: il CISX E CXECT (PAYABLE
TO NHC) [ AMENTCNN EXPRESS E 'CU"SO fl O'SCOVCN
X*******r<{<*.r.X{<*****r(r(*r({<r(*r(******r(*r(***,F**r.r(***********r(r(*{.****,k*****{.**********{<{<j<*{<*r(r.
ZONE:
_ OFFICER:
Appnoval:_ City:
(FOR OFFICE USE ONLY)
SETBACKS: F:
REVISED DATE O4/IL/L2
BFE+2ft=DATE:F LOOD:
LH: RH: B:
W. tstaaf
co ts - b'l
b?
APPLICATION
Number
tor?ii"T"l
klat
tttts E Ns*t4 oo.,,,7b//t-
PHONE
*:
PRO]ECT ADDRESS:
SUBDIVISION:
PROPERTY OWNER'S t,lAME:
OWNER'S ADDRESS:
CONTRACTOR:
ADDRESS:
EMAIL
PRO]ECT CONTACT PERSON:
NEW HANOVER COUNTY BUILDING PERIIIIT
aPPLICATIoN
ryPE; DEMOLITfON
PIEASE PRINT CLEARLY
& ANSWER ALI- QUESTIONS
"Project Responsibility"
tJs P tt/rat 4APPLICANT' S
DEVELOPER:
BLOCK *:
_@k/
LOT #:
?A?E r:78:/?V1*;jZE:$ac,L
DEscRrprroN oF r,roR(: n*tzl<.2 t40Ul zf
(khat Iype
of Building Do You Iant Io Demolish?)
and ordinances and regulalions. The NHC Developmenl Services Center willbe noiified ofany changes in the approved plans and specifications orchange in conlractor or
O.'NER/CONTRACTOR:
src^oru 7z64) P,
* rt* * * rt
*:t * *,* t * * ? * * + + * ** * * * * * * )*** * + + ** )*
** * )t****:*,* )*:* )***
*** + )*
+* {(**,t:t***** *,**,}** )** )r
*,* )r,*+ *+ + +
rs rHE pRolEcr: ffnrsrorrrtnl 7
! commrncrnl roraL AcREs DrsruRBED:
TOTAL PROJECT COSTrressrorri
* {fSaf,'---2-ExrsrrNc LAND
DrsruRBrNG pERrilrr?
[ ves @.fio
DoEs rHrs srRUcruRE oR BUTLDTNG
coNrArN AsBEsrosl
I ves @r{ii
rs IHERE A NATUML GAs LrNE coNNEcrED
To rHrs BUrLDrNcl @/vrs
[ ruo
Is rHERE ELEcrRrcaL powER oN THrs BUTLDTNG?
{vrs fl no
WATER: ETCJPUA
SEWER:
El( FPuA
coMMUNrry svsrem
fl pRrvArE r^iELL
cENTRAL
sEprlc I rnrverr srerrc
fl comr4uNrry sysrErl
Nots: The National Emission Slandards for Hazardous Air Pollulants (NESHAP) Regulations Requke thal you contact them al (919)707-5950 at teast 1O
days prior to the demolition of any facility or building, whether the facility or building was found to contain Asbestos or not. Demotition notificalions &
asbestos removal permit applications are lo be submitted using the application fonn (DHHS-3768). This form can be found on the web site shown below.
Note: Obtaining a demolition permit from the NHC lnspections Dept. does NOT satisfy
or meet the nolification requirements of the HHCU (Health
Hazards Control Unit). *Keep in mind that an asbestos suruey is required by a NC accredited asbestos inspector prior to any renovation or demolilion of
a facility. Please see the Asbestos Web Site htto://www eoi.state.nc.us/eoi/asbestos/ahmD.html
(Print Na
e)
nn
pAyuEr'rT
[ErHo): ficasx I cnrcr (pAyaBLE To i.tHc) fiaru rccourr f] uasrrncano
ffir*
** )t,*** **,*,t)t*,* i( )** xr. r* ,*
* + * *,* ,*
i(,* ,t
* ,*,*
* x** x*+r*,i,t* x* )t,*+ rt,i* rt*,t)k**x * ** * )t*j*x*:t*:t*** **)k* **+,t* *,r )i )**
*
(FOR OFFICE UsE ONLY)
SETBACKS:
F:_ LH:
_ RH:_ B:
FLOOD:BF E+2ft=
ZONE :OFFICER:
Approval:_City:
N
PERI4IT FEE: $Comment:
DATE:
PHONE
#:
NAME :
CITY:
*,
f4/?? accouNr #:,, i. .
-
e,4l t r1&r@O )
4 tl (l','n3e7 one nnd't ?€z
lt- Itoq
NEW
HAN9yER
couNry BUTLDTNG pERMrr
aO l5- Lrl'aa
APPLICATION
Number
(office Use)
APPLICATION
TPE: RESIDENTIAL
PLEASE Ai]SWER
ALt QUESTIONS APPTICABLE TO YOUR PRO]ECT
"Project Responsibilit)/,
PRO]ECT
SUBDIVISION:
PROPERTY O},INER, S NAIiIE
I
OHNER'S ADDRESS:
CONTRACTOR::.xr lr-.
AODRESS:
PROJECT CONTACT
DESCRIPTIOI'I
oF l,joRl(: (c,rwr
SQ FT
SQ FT
APPLICANT,S MI'IE:
OEVELOPER:
CTTY:
LICE NS E
CITY:
:N
sr:\L zrl:J(LIII
PHONE
#:
PM)NE
*:l1q:+qrat".;
T.PLTASE CHECK
! arr ernace
SF
ounr-rx
! TohlNHousE,.k t,,, g.+een<.d
,**,t* *:t * )*** * r****,****:t,t
TOTAL ACRES DISTURBED:
ZONE:OFFICER:
Approval
:_ City:
B:
_ BFE+2ft=
N
PERIIIT FEE: $
ExrsrrN6 co srRucrroN: pfalrenarroru ! nrnovarror
I cetrnal nrerrns
I RELOCATTON
I{EW COI{STRUCTIOI,
! TNTCT NEW RESIDENCE
O"
f] ADOTTTOU
rO EXISTIIG RESIDENCE
AND AI{SWER BELOW
AI.L THAT APPLY TO YOUR
PRO]ECT:
-
sF fl oer caRner
sr [2J roncH
I sur'rnoor'r SF
! eoo r-
_ sr
I sronace sHro
OTHER:f] cnrruousr plorcr
.ll(r sr
TOTAT HEATED SQ FT: -. ToTAL
sQ FT UNDER
aooT,
J.5L ToTAt AREA
,q,,, 4 bV
ToTAL PROJECT CoSTlresslog
, $ lryD-O, f OF sToRIEs:
rs any ELEcrRrcaL, PLU[Brl{c
or !4Ec(AilrcaL work Being Done
to the accessory stnucture?
[ v", f,torf the project
is a Relocation,
is there a Natunal Gas
Line on
the curnent
site? ! ves pf ruors there Electrical Powen
on
this Building? p[ves [ ruo
PROPERTY USE
/ OCCUPANCY:
ffi NGLE FAMILY
,iri* i+r**+r***. +********,f
**(:;Tllil"l********** *** *,*y'********
rs rHE pRopERry LocArED
rN
n rloooplerrul
l-l yes d w
EXISTII{G IITPERVIOUS AREA:
_
NEW IIIPERVIOiJS AREA:
_
,/
wArER:
f] crnua
[f comr,luNrry
sysrEr,t
! lnrvare
wrr-i
! cENTRAL wELL
srwrn:
f] crnur
I cENTML
sEprrc
I enrvarr
srcrrc p/coluluNrry sysrEll
*** SEPARATE PERI.IITS REQUIRED FOR ELECT, MECHJ
PLBG' GAS EQUIP, PREFAES
& INSERTS **,I
pAyilErr ErHoD:
!cas* florrc( (payaBLE
ro **c1
[ menr.on
,ir*ri, fJ n.friri -Errr.orm
)*
*,*)* )*
*:* :*:* )*,* )*,**,*
**** *x)x **)t* * !t:t )t
* :t:*
***)* *.*,i,f )t)t*)*,*** *)*)*)t ** )*+
*,t* **)t *,t **,* * ***,t )t )t )*
*,t
*,t)***,i*** * *
(FoR oFFTCE USE ONIY)
SETBACKS: F:
.\"rld
DISCLAIMERI
.::-l,-ry_lr_t"-,.,::]i:,,:l 'n
his applicarion is
corecr€nd al-workwi comptywih he Srate auiBins code 6no
arror,", uppricaur" srar"
anaIIIIand ordinances and regulations. The NHC Developmeni Se rvices cenier willbe noil5ed
otany changes in he spproved pb;s .rd speciltcation;
conrracror rnb rm
arion. '-NorE Any
wort Pertorm ed
wo rhe Appropriate pem irs wil be in vio tation o t rhe N
c sraE Btdg
owNER/coNTRAcrontM STGNATURE: -z_
Exrsr LAND
DrsruRBrNG
ernnrr: f] yrs [--l r,ro
REVISED DATE
O4lI1/12
LH: RH:
comment:
DATE:FLOOD:
PHONE
S:
EII'IAIL ADDRESS:
PHot'tE
f :
?rz 6 -\8\6
p.2Jr,l 07 15 03:34pDavi66 Contracting 2526224753
,$1 1:.1l*- Jo 15- gtt1t
-,:.. r"' nF NEI.| HANoVER couNTY BurLDf NG PERl4rr
d[* $3i aPPL.aarrott rY"E" RE5TDENTTaL oppLrcArror\
6E.j
,LEASE a"<'!sri!(
Qrrs'il;;:ilr;** *'*'
,#,r';,
1\-/
APPLICIII'5 UAX:: l!!Id:-c-: rri::her DATE|-
DEVET-OP€F: Pr$xE
s:
--PROSE(T ADONESS:
suSDMSlOll:
1)ag "Jloe! :tnac:1 Dr.CITY: u:iiiic:cl:
BLOCX *:
-L:rENSE *: ?rti9
LOT {:
zIP:
:!r!9:
PROPERTY OIS{ER'S 1q11p; rree:ira sperce: - Pl{Ol{E
orfllrR,s aoDREss: :.ooo Jpper lles.h rr. crTY:
!ilsi-!.9.!9l--
s: LL9,::21:!-:.91-
sT:
]l zrP:r3g!-
(O''TTRACmR
: Ae!f,r- i!:-,Ij::!-iiE
ADoRESS: 5!02 li,!' ,i ir.r!_ CI'Y: xcre::ea<i ci--w.- __ STr!iZIP::95:a
EiIAIL AmRESS: c.f !:chc r-;.hv-s.. nl-t:.. ! :-:,sr:r - cor .- PHOXE S: 2s2-a22-5181
PROIECT CoI{IACT PERSoNi chnno:,e:' !ul.:er -PHOtiE r: 25i-r:2-t|J:
EX:STrNG CONST&j(TrO :
I ALTERATTON
f *rnovartoH
I celenal erclras
f] RElocarlotl
flEI.J CONsTRUCTION;
I TNTCI }IEh RESIOENCE OT
fi MOI:TOI TO
EXIST]I'I6 RESIDENCE
.'PLEASE CHECX AIO A'I5I/Ei ACLOI{ ATt T']AT APPI.Y TO Y'{'A PiO]EC':
flatr c+rnacr
-
sF I orl caraee sr
f ponor
-sF
Ll suNRoov,
_ sr
! cnremrouse
--
sr
f-l pocr st
fl otc,< r-r
(ron
or (t l.JsE o{Lr)
f srouet sHED
*-- sF
SF OTHER:
ROOF :
SF
TOTAL HEATED 5Q FT:TOTAL SQ FT UNDER
IOIAL pR0JECT €OsTiiersr-ort: I j;-q-S-a-- f OF STORIES:
pRoFERTY lJsE
/ occup!'&KY:
ifl srNete rafltlv
I ouertx
[] roruttoust
OESCRIPTIO Of I,ORK I
TOTAL AREA 5Q FT:
ts Any ELECTRICA!, PLUi{8rnG cr t'lEcllAxlcAt ,o.k a.ii8 Done
to ihe Accessory St'tlcturel f} Vgt S ruo
If the proje.t is a Reloc.tion, is therc a llatu'al Ges Lire c:1 ti€ cur'eni sitel f]ves fino
Is there Ele<trical Po,xer on thls Bui.rding?
Eves f]lo
Lf* l *"or.- ry t.( d dro,mrlir ii $s {ppt":i i ct!'l6d J e't tt coaElt wltri !E Sa' B-.rd'nn C'dc 'd 'l'j
olr'r
fiIi"*i-.,
",ii
,"'E",r*" r,.eNhc o.wintdenr s€(tes c€'s' lrr oe r€t! ,'d o' arvgle"' li".Yj::t::":9.y11:
-"*J,.t-no,i1'r'r,:ra .nt A
crk tsljroth!.-wc !r'- rtr-t",irlr ,r
rlt*i'
"
i vobr'^ otic ic s*
oH E R/CONTRACToR :SIGI.IAIURE:
Erc
DT 5'OYIR
15 THE pRopERTy LocAr€o rN I rlmoeurrur
f] vrs fi m
EXISTIT.JG II'IPE RVlOUs
tJEt,I ITIPERVIOUS
u^rER:
Z creur,q
f coFr4urlr av
svsrrx
E PRTVATE I'JELi"
f csnrul uert
sEuer:
fr cFPu^
ff crNTRAt stPlrc
[]] nn:vrrr s:prrc
f] co+{rflrrY sYsr Er
.t:sEt'ARiT.PER,n!T5REqJIREDFoiEl.€.T,lt€cll,PLBG,6AsEQUIP'PREFAaSS,I}lsERIsa
,orrr*, n**oo]-
'-i
.oin
E.*t* (prYAsLE ro nxcl
E erty-cor-111ess LJ r'c/vrsa
L
-'.,--'-..--';'"'
AREA:
-_5Q
F"I
AREA:
...--SQ FT
IOTAL ACRES DISTURBEDT
,irir .*, DrsruRBtNG rr*rt, h
-
(ton 0rr1(c tJst o'lLY) ,, I
0-lt oorr.r*, 1t, , SEr,ocKs' r' pl r-x: r'[ en'
'/5 ?,a' 5-- '
coment: ; ;il;;;$; 6 !rl; ii q lrl:25{ 0fi$rr
FEE
[F'1 inSpecli0n Re0ulreo Y I
u'/ir'r'u7r,
NEh, HANOVER COUNTY BUILDING PERII,IIT
aPPLI:ATIaN
fwf : RESIDEi{TIAL
PLtASt AtiSxER AtL QUESTI0|,,1 AFPI-191q315 :0 YOLP PROlt(I
"Praject Responslbilit/'
20(S-b?71
APPLICATIOII
Number
(offic. urr )#
PROPEITY OhFIER,S
*r*n's AD0FESS:
CoilrRACroR: t/.\L\!trJ M', t-\^r-t\
ADIfSt: r\ tr \\- r'; 'nS
PHoilE
$:
CIIY: u
) r r-,r , ,r$ !r.: rr ST:
_
LICEI{SE *:
5r:
!!. zv: eg'/241
ti
PHor.E
s: 9
l0"lrro :}qs.l
CITY
'Er{aIL tDDREss: l-l.r,ti\ul.r rt O }ii, rg'r. gprz-l . / C.r-t
pRo:cfT cotlrAc? PE*SONr
l4c\\d*. \ vLV-l*-l i
OTHE R :
0r.r!lER/(ONTRACTOR:
PH$TE
Exrsrril6 cottsrRucrloll,
I llre nauoil il RENouArroN
&erg*o'- ,tEpArRs
I nilocnrron
t{Er.t cor,r5rRU(TIOH:
f rnecr NE}J RESTDEitcE
or I AD0:rIoN To ExIsTIr,lG RrsIDrficE
..PLEAsE CHECT AI{D ATTSHER
EELOId ALL
'}IAT
APPLY TO YCIJN PRO]ICT:
f arr 6AMGE
-
st I oer GARAcE
f sunnoou
-----sF I eoor-
_- sF
f enrrNxousE
-
sF f oecx
-
sF
SFI IPORCH (r
f sronace sxro
Elatioh of thc NC Srore b..:qf.:.rec= :.. :_-,r
STGNArURE:
JAI,elU
.sF
SF
TOTAL HEATED SQ FT:
ToTAL SQ FT UNDER RoOF;
TOTAL AREA 5Q FT:
TOTAL PR0IECT COST(tessr.,,$
I f ,Ae.*L fl OF STORIES:
Is any ELECTRICAL, PUJnBIllG
0r ilECHAtICAt hbrk 8ei0g Don€
to the Acressory
Structure) [ Ves [ ruo
if the proje(t
is a Relocation,
is there a Natural Gas Line on the Current Site? f] "g5 i tto
Is there €Iertrical Power
on this Buildint? D yes l_l lto
pRopEnry usE
/ occuPAr$cY:
* srtelE FAHTLY
f! ounr-Ex
f, ra,lnxousr
DESCRIPTIof{
3F ll0*l(r Lt!:;.' r
o.".-,\ c+,.t.. ,-S nr",'ir.) t.r.Vu 1i\f t fol- 1',
lqf N.4Llrr:
*tS, f\i.ll}i !ri'Hl C tnqr
:'-.itll'l.:':,1enifyh'l,linbrnsii0nlns:Sar,p1lca|iCrlis:orl:'...,t..|..--;:'..-ll.:
end ordnerccs end tegulesons T
tE NH
C D{ yehprnor I Se rvEes Ccn'ler will
b€ ootfrod ol sny
chsngos m tli€ Bpprovcd :1rr, t ;'ic 5r,r, i,t;:sni cr ci,ame
cstr&til obrmstqn. "1{OfE:Ary Work Pedomed WrO he Appro2,ioE Pcmiis wilibe ioViolotion ollhc NC SlsE 6r:.a
f,:y€1{:-.j\.t O f
-e6'
ExIsTIlS IllPtRvfOuS AREA:
-5Q
rT
tlEl.J IHPERVIflTS AREA:
-
SQ FT
r+r+*.r**r'r++rf,x"ir*i**+***(l:'ili:TJr+**r*{**!*r++r*+*rr**+r*++*.tri.rrra**rr*+*r..*r..r.
rs rHE PRoPERTY tocATED llr A FLoooPLAIil?
rc YEs f] *o I t t ;: .. - .,:L' i i:1'" t- \
TOTAL ACRES DISTUREED:
Exrsr LAI{D DrsruRBrNG ptnflrr: [l vps
I rro
f] colrnunrw sysrErrr
fl pnrvlrs we u I crt*lrRll r,le ll
I crurnau sEpric l]-] i,nrvart sEprra
I conm..rnrrv sYsrtr
zolE: i-1,-
rl, 0FFTCER: :-' -i "
' (::'r,
UIATER: ffI CT'UO
:1A
SEl,lER: b_J cFPUA
A,sPLIcAltT's urc,
ilc.\*L*-. M, Lt-l^el\ . oarr,
DEVELOPER:PHOi'lE i:
Pf,O]fCT AODflESS:L,'.I\'1 R'.Tli
dg ij -@l ZIP:
\!
BLOCI( s: LgT
fl:
NA}.IE:
\r
FLOODZONE
'TI !EPAflAlE PERIIITITS REqJTRED FOR
ELEC1, I'IECH,
PLB6, GAS EQUI,PJ PREfABS
i' IN5TRTS
"'
pAyrirEitr
lrErrmD:
f casx
f].rr.r (PAYABLE
ro NxC)
fJ urrnrcmr ExPRGss
fl r./rrro f otscovrn
**r**+****atl*t,a*+**r*l**|l**r+$$l*tt+****r*i*l**tll*ttr,l.**r*.t*lartttrr+**r+f+r***ar*+*
(ron
orrltf utf o{rYl htwsto DAr[ B4l11/1r
sETBAcKs: r:Nik lx: \'il' nn:lali g: lV7-
Conment:PEI,AIT
FEE: S
. ,-r
Approval :-- C itY : ',r-' i .
i'i :'
-y
APPLICATION
Number
(offi(e Use)
/ - '"'1- t <a"(o a-z- t )
z,,Pl. ??4lt
OIINER'S
ADDRESS:
I'IME:PIoNE
#:
4ta
3{z-ffi1C_sr:Nczrp 214
ll
sr:(E zrp:
ZLq I I
clto -3fz-f,qlu
L
ICENS E*:
CITY:
PHOIE
f:
PHONE
S:
RENovATToN
! cenennl nrcarns
fl RELocArroN
I{EhI CONSTRUCTIOI
I
! ENTCT NEW RESIDENCE
O"
f] MOrrrOr TO EXISTII{G RESIDENCE
I"}PLEASE CHECK AND AI'ISWER
tr
YOUF PROJECT:
5F
If the project
is a Relocation,
is there a Natupl Gas Line on the
Is there Electrical Power
on
thjs Buildins?7[y"r l*l wo
,..
PRoPERW usE
/ occuPANcY ,
E{rror, ,orrr! ou2ir4
[ rowuHousr
r/1.
?EZ 6-tt vo
NEhJ HANOVER COUNTY
BUILDING PERMIT
?ott- 6?B3
ffi
APPLICANT'S TUTIIIE:
DEVELOPER:
PROJECT ADDRESS:
SUBDIVISION:
PROPERTY
OWNER,S
CONTRACTOR:
ADDRESS: I I
Ei!AIL ADDRESS:
PRO]ECT COi'ITACT PERSON:
EXISTING CONSTRUCTION:
l-l alt crnacr
flru"^oo, 2-V7-;
! cne ruousr
-
sr
! eoor-
! orcx
ToTAL HEATED SQ FT:
_ ToTAL SQ
TOTAL PROIECT C0sTlressroq
, $ tr//(
BELOW
ALL THAT APPLY TO
sF ! orr cnnaer
APPLICA|ION TYPE; RESIDENTIAL
PTEASE AI.ISWER
ALL QUESTIONS APPTICABLE TO YOUR PRO]ECT
"Project Responsibj.Iit!/,
DATE :
PHONE
*:
BLOCK
S: _ LOT
*:
sr l-l poncs sF
SF
I sronacr srro SF
SF OTHER:
FT UNDER ROOF:TOTAL AREA SQ FT:
# OF 5TORIES: I
Is Any ELECTRICAI-, PLUt4BIt'lG
or I4ECHA
fCAL
lrork Being Done
to the Accessory
DESCRIPTION OF WOR(:
structune?
[ ves f] ruo
current site?
lv"t ffno
an d ord in
6nces and ,egu iaions The NB
c De velopmen I se rvices C€nter will be noll5ed ot an y
chsnges in lhe appro ved ptan s . nd specitications or chanoe in co n
lracb r or
conracbr mbrmauon. "'NOIE AnyWork Pero{neo
w]gqe fpprop,iaE P€milswilrbe in
vnrai'on ollhe NC SlaE Bt99gd6l ano Subjeqt lo rhes uplo
owNER/coNrMcroR:-\i/""r+hu\ *)a\"^<"^ srGMruRE: -) o-*-1 ",
t v * * *,t * * * t . * * * *,*ffi * * * * *-* * * * * * * * *k -*.T IIIII,*** )r***,****,t,tr()*,t,*** **,t r(*,F*.*+** * )t )t )*)t)t** )*:1*
** *r*,|,* * * )*
*:* r*** *,t+ *,t,t *'r** * * *
*\1:2/* *
rs THE pROpERry LOCATED
rN A FTOODPLATN?
I V* ffnO
EXISTII'IG IHPERVIOUS AREA:
-SQ
FT TOTAL ACRES DISTURBED:
- il;;;; o**, - ,q ,, ,rrr,
,o*r-rrtr;;; ,,**r. E ,r, /*
wATER:
! ,rouo /r*ruNrry sysrEM
! enrvrre wEr-l
n cetrnal wrll
sEwER:
f] crrun
f] CENTRAL
sEprrc
! enrvarr seenc
p coMMUNrry sysrEM
*** SEPA,RATE PERMITS RTQUIR[D FOR ELECT, MECH, PLBG, GAS EQUIP, PREFAES
& INSTRTS +*'
pAyrilENr METHoD:
! cosn
lcxrcK (payArLE
ro mrc;
I AlrenrcAir ExpREss
fJ naZrrso
I orscovrn
)*r** * *,1)t,t * * i( **)t* ****,t+,t )t* *,i * )** )* )t,t * rt*)i)t )*)t)i* * )*:*,* :*:* * * * r* r*
*:t ,* + r*r*+
**+ ****:* **** * * r*
**)t* **** *** *,t)*
ZONE:
_ oFFICER:
Approval :- city:
(FOR OFFICE UsE OIiLY)
SETBACKS: F:LH:_ RH:_ B:
REVISEo D TE 04111/12
BFE+2ft=
PERMIT
FEE: $Comment:
DATE:_ FLoOD:
(€L \5- lTll
NEW HANOVER COUNTY BUILDING PERMTT
APPLIcaTIan
ryPE; COltilERCfAL
PI-EASE AIISHER
ALL Q{JESTIONS APPTICABLE TO YOT]R PRO]ECT
APPLICAI,IT'S MI'IE !
DEVELOPER:
PROPERW OhiIER'S
OT,IT'IER'S ADDRESS:
PROJECT ADDRESS:
occuPANT/BrrsrNEss
COI'ITRACTOR:ELFoI(
ADDREsS:
EIIAIL ADDRESS:
PRO]ECT CO,ITACT PERSOII.'fi Coa6\
LrcErEE #:
b5672 Accor,lr *:
,/ lche.k all rhat apply)
EXrST COt\6TRrrTrO
:
I alrtRarron ffitxovlrron
I cettRAt_
F
nffii, is there a NatuIal c6 Une on the Current
Ste? l_lVes l_J m
l{El,,r
col{srRrcrroit,
! tnrcr NEti sTRrcTURE
I rasr rnacx
I sxelr-
! unrrr
! aoo ro Exrsr srRUcruRE
ACCE5SORY STRUCTURE:
If UPFIT
- The SheUPermit #:
rs Elect Polrer on
this Building [f/yes f] uo
\----J
oF occuPArEY usE? I lYEs D1l r\E
tihat is t6e ilel.r(kcupancy Type?
NC REG
*:
NC REG #:
b*,r
ls rood or
b€v*!g6 papared
c eewd ln tir ouctroz flve" ffi6 r nc cropaty Locrtad ln Ths FloodCrinz
f] ves
fl No
DISCLAIMER: I her€b) c€rtjty that allinformation in this_application iscoflet and allwork wttcohpty with th€ Star,e Burtding Code and
a oth€r appticabte Stat€and bcar raws and ordrnsncesand requtations. TI|e NHC DevetopnEnt Services Center
willbe notifi;j otany chana6s in th; sDproved Dtans and
ibecificalionsor chanoe in contEctol or c.ontrscror inrom,tion. -NorE: AnyWo* P;dormaa W/ciih;Approp-'i;te p;;i& ;;iiii5-in ViiiEr"Sd,lii-ri. [|C si;i; dfd;i;;:;?Subi€dio Fin€s Up To
$500.00-
OWNE Rrc o NTR ect Oa: r{t aat
t /.rrr1 nr &-qt a
- S I
GNATU R E :(q.lli.4 (p
rtrd)
conch A.b..E o. noi You
rlr r.qullr(l E c.ll th. Mtoh.l Em i.*rn sa.rdrd. lb. t-t
rryitott Ar PotluanE (NEs+lAp)
.t (tIo)m7soso .t b..r .lO (by. p.to.
b t
domolhbn
ot.ny fbcility or tulldin!.
8.. A.b.en W.b si!.i hte,/ir$v.c|r.!Ets i,c
r,ri,pjinjldlrlr,.ahinE i,a,n
TOTAL PRoJECT
cosr. i 4 5,.
?-9.9. BUILDING
HEIGHT:
6 ,
# oF UNITS:/
TOTALAREASQFT: 1, ro4 SQFTpERFLR: ? Zao * OF
STORTES: Z
TorAL
so FT
UNDERRooFt .?,
toD # oF srRucruREst / * or rloons: -l-Z--l--
ACRES OISTURBED:EXST ueND DISTURBING PERMIT?
FVCS
ffiO
NEW IMPERVIOUS AREA:SQ FT EXISTING IMPERVIOUS AREA SO FT
pRopERry usE floFFtcE flnrsrnumrr [uencerrru
I eouc
/enr lcouoo ornen
WATER EGFPUA
fl coMMUNlry
sysTEM
EWELL E:]zoNrNG usE cLAsslFrcATloN:
sEwER: ElcFpuA IICENTML SEpTtC
E P-RIVATE
SEpnC ECOMMUNIIY SysTEM
REUSED EIAIE Ifi1N2
***** IS THIS A CHA,'IGE
t.rar the PrevLous Occupancy l)lqe?IF Yes, what
ARCH DESIGN
EI,IGR DESTGN
PROFESSIOML:
PROFESSIOI{AL:
DESCRIPTION OF WORK:
ao6-@188
APPLICATIOTI
urber
(offtce Us€)
OOrrr
dft
zrP:
Zt./d3
Ptror{E
*: 1P
3?5'*7tr
srtA)LztPtZ
t.le
S'r: AJC zI.Pt ZTbl 7
*: _i t9Jl2_#/6
P+o E *: t-9t?-Goo-<1/?f
REPATRS
E RElocArror{
rs BLDG sPRrNKLEneoz
I v." f,]x6
1PERMIT FEE:
$_
PH:
-\rh Fr-ts
-i Mcu5. r L.G. lris Lu{
(pAyABLEro t.rtc)
[eru rccouur flMcildsA I uscovenPAYMENT METHOD:
titrur
.' t
, ,g$ ,,
APPLICANT,S NAIt,lE:
DEVELOPER:
NEI^I HANOVER COUNTY
BUILDING PERMIT
APPLICATION TYPE; FACILITY LICENSING
PLEAsE PRINT CTEARTY 8 ANSWER
ALI. QUESTIONS
"Project Responsibility"
E xer,.liw ){rtr < Zn r
?ots -
67q\
APPLICATIOI'I
Number
tOlrr* rlt" I
PRO]ECT ADORESS:
SUBDMSIOI'r:BLOCK LOT
LICENSE *:
ST
#:
s:
6-
PHONE
PHONE
vz
J3'/z
( FOR OTFICE USC ONLY)
SETBACKS: F:_
FLOOD:
LH: RH: B:
Aa\tseD 4/!2/72
BFE+2ft=
N
DATE:
PROPERTY OI^INER,s NAI'IE:
A A \ i'I."",T PHONE
#:
owNER's ADDRES5: T t sr,,|192w;!1143
CONTRACTOR:
ADDRESS:
EI{AIL ADDRESs:
PROJECT CONTACT
! rourr cane
! orr,-, .o*u-rrrt't5;T,-IT^if:lL"
I cHrLD CARE
crr,rrrn flrie
DESCRIPTION OF IIORK: t,J , ,t
t nf ,, f c t,u
< "
/( $,a{
**** * )*,*
* *,t )t )t )t
* )t* !t
****+ *+,** +**,**)t** )* )* )k
* ***** )*
*,* * )*,*
* ******* )*********+**)i**)* )* )*+,*,i * * )* )k
** **rk)*
and ordinances and regulalions. The NBC Oevelopmenl SeNlces Center will be nolifed of any changes in th€ approved plans and spec,ical ons or change ln contractor or
contractor rnformaiion.
'"NOTE: Any Work Pe ormed WO the Appropriale Permits will be in Violalion ofthe NC SialeBldg Codeand SubjeciloFines UpTo$500.00"'
,al
OI,JNER/CONTRACT OA, y'fohZI KUChE-'' 5IGNATURE:7 (".* t",")
TOTAL f OF PERSONS UNDER CARE:
rs cARE To BE pRovrDED oN A 24 HR elsrst
I ves
[ ruo
IF NO, WHAT ARE THE HOURS PER OAY?
WHAT IS THE TYPE/CLASSIFICATION SPECIFIED BY THE STATE LICENSING AGENCY I^IHICH YOU ARE APPTYING?
rs rHE pRopERTy LoCATED rN A FLooDpLATN?
[ ves
[t r,ro
rs ELECTRTcAL pot^lER oN THE BUTLDTNG?
ffi ves
[ ruo
rs a NATURAL GAs LrNE oN rHE pRopERTyt I ves $no
TOTAL SQ FT:
** PLEASE ATTACH A COPY OF THE APPLICATION & FLOOR PLAN YOU ARE SUBI4ITTING TO THE STATE **
wArER:
\ Crnun
! CoMMUNTTY svsrrm
! PRrvArE WELL
sEwER:
[qcFpuA
! crrrnnl srcrrc I enrvnrt
srnrrc I coMMUNrry sysrEM
**,} SEPAMTE PERI'1ITS REQUIRED FOR ELECT, MECH, PLBG, GAS EQUIP, PREFABS
& INSERTS ***
pAyr{EMT r4ErHoD:
EcAsH flcxrcx (PAYAELE
ro NHc) [ aru rccoum I mclvrsr I orscovrn
* )t** )***:** )** * )** )k
**)*** r(,t * ,f )t+
***+ ** * )*)**
**)*,t***,t **,t)t*i( * )t*,t** )t
**+ * *r* *rt*** ***** * **+)t)t *!t)*** +***
zoNE:
-OFFICER:
Approval :- CitY:
Comment:
DATE :
PERMIT
FEE: $
ACCOUNT *:
NEW HANOVER COUNTY BUTLDTNG PERMTT
aPPLICATIOT'|
ryPE: RESIDENTIAL
PTEASI Ax9JEn
Att QUESTIO S ApplrCABrE TO yOUff PROIE(I
"Project Responribility"
.rOtS-ta8CD
LOT
,rcrc *{/.,
APPLICAfiT',S
DEVELOPER:
M}tE :
h
PRO]ECT ATDRESS;
5UBDIVI5IOI{:
PROPERTY
$',NER'S lutflE:
OLINER'5 ADDRESS:CITY:
. LICEIISE S:
crrY: till;
ElllAIL ATDRESS:
PRO]ECT COI{TACTPERSOTI:
ExrsTrM coNsT[ucTror{:
fl arrtnnrror'r
fi nrrcvarrot
I e rrurnar neearns
fl RELocATIoN
lrEW COTTSTRUCTTOT t !,SneCr El, RESTDENCE
o" E ADOrrrOt TO EXrSTrirG RESIDENCE
'.PLEAsE C!{GCX O,TO
II,S,E*. EETON ALL THAT APPLY TO YOI,R PROJECT:
larr caRaor
_ sF I-l orr
eanacr sr
! noncn
_sF
D surnoom
_sF I emL
_ sF I sronace
SHED , , = n,lhr_h J-:,.-lcnerirHanst- sr f]orcx _ sr ontn: 6A{L\l}:*": . ""_ En)arat'n*
)(;]olenq- KPaxrfrctU of
fu
roTAr HEATED
5Q Fr:
_ roral sQ Fr UN0ER aoortltQl Jr6ral AREA
sQ F"rt35){
TOTAL PROIEGT COST 1r.css r-ory : S 250,0il00$ OF STORIES:
Is Any EL€CTRICAI, P(intBI G o. T.iECHANICAL
wo.k Seing Oone
to the accessory StructureJ
I Ves fi[ UO
If the prcject
is a Relocation, is there a Natu.al 6as Line on the Current
Sitel flves ffiUo
Is there Electrical Pow€r
on this Suilcling?fives Iuo
PRoPERTY uSE
/ oCCUPANCY:
fi-
DESCRIPTIoN 0F I.JORK:
4
no(
faz l{- llrtg
APPLICATION
Number
(Offl(e Ure)
r1Q.oo'rr, 6
/tO/t{
PtfiNE
*: ty'/E:
si:
l/Cz*,27(l/
remtlY
l-l ruprrx
OlSCLAllr,lEft I heeb, cern, lllal at inb.malion in ilis applcaaon A coiecl a.d all wort wi8
comply wih the Slale
and o,rlinarces rxl reguLlbns. fh€ NHC Oelel'cpmerl Seoi:es C2nr.r sill be nolifisd ot any chages in
he +ptovod
(Print tcr)
:i:r r 'l **,t a*r a * t ta **** *t+a*at **t + t** *,*+ *:*aa {, *r r *,} r:** *,r *+t**
and a! o!r€.
aortrbb Si.r
sp6cift.liss or
ch!.D. h
IS THE PiOPERTY LOCATED IN A FLOODPLAIN? XI YES I UO
ExISrItG It'rPERrrIot s AfuEA: juz-sQ Fr TOTAL ACRES DISTURBED: .03
EXr5T LA rD DTSTURBTNG PERr{rr;
l-l vrS
xl loNEr"r tl?ERvrqrs ARE^t
2i.4;- sQ Fr
uArER:
I creua ftfcomnuNrrY sYsrEr4
fl enwnrr
wrr-t
f] (EilrRAL I'IELL
sEl{ER:
I cFpuA
f] cE TRAL
sEPTrc
ffi eRtvarr sEPrrc
E co]4lrrNrrY sYsrEt4
t.. STPARATL PER}IITs RIqUIRT' FOti I]L€C]', IIECH, PLEG, 6AS E$J]I,. !'REFA8s S IIJSER]S '''
pAyirE[T
]tEm@: ! casx
I crec( (PAYAaLE
m rurcl f]ertr rccorxl I nclvrsr f] orscow*
irraa,itrttfa t.it,i:it,iaa tatra:t* t*+r +*r r*{'r ** *,} **r**{!* **** **** *** * ** * *rt* a!*!i* t*a trt i,i {ta* + t *+ t.*
ZONE ;OF FICER:
Approval:- CitY:- DATE:- FLOOD:
(for ofrra€ t6a o|tY)
sETBAC(S: F: LH: RH: 8:
navtS€D oar€ o!/1r / r,
8FF +2 ft=
t{
PER}IIT FEE:colrfmnt:
BLOCX f:
ADDRESS:
P}IONE
PHONE
ACCOIJI,IT T: