SEPTEMBER 22 2015 BUILDING APPSffi)'
*^" **T*" Ii'il'Ji:ri: -: "{':'zq1q5:;:H;#;"iffi:#;frr-$
M,'IE:
NEt^i HANOVER COUNTY
BUILDING PERMIT
APPLT@TIoN 7yPE.. RESIDENTIAL
BLocK
*; TA+{,T C LoT
*I
/ s-a,77p .
nppEdrrou
Nunben
(offtce Usc)
oorr. gfzr/r
W*,(zsdgT?-tos
PRO]ECT ADDRESS;
SUBDIVISION:
PROPERTY OhINER'S
OTJNER'S ADDRESS:
APPLICANT'S
DEVELOPER:
CONTRACTOR
'AIX'REss:
?lP.
Zr(d3
*:
EIIIAIL ADDRESS:
PROJECT COiITACT PERSON:
srW67rTE
LICENE
*: ACCOUIT
*:clTt: ta/,l,t\L* str@l@r pHoNE
*:
PHONE
EXrSTrr{G
coNsrRucEoil:
I alremrrolr
f] nelovarroru
fl oeruenal
neca:es
I RELocATToN
NEh' COTISTRIrcTIO
. fi ENECT NEN RESIDENCE
O"
I AOOrrrW TO EESTING RESIDE CE
*TPLEASE CHECI( ATO A}JS9IER BELOI{
ALL THAT APPLY TO YOIJR PR,OJ€CT:
Ferr eanaar
7ZO sF f] orr earorce sr [nonqr
_sFI sur'rnoom
_sF f] coor_
_ sr I sronroe
,rro
_ ,,I eReeruno.rst
_.- sr I oecr sr orHER:
_ sF
TOTAL HEATED
sQ eTI gLO ToTAL SQ FT UiIDER
noor /lOu}_ ToTAL AREA
sa
rr: LOLO
ToTAL pRoJEcT COsT(r-sr-oo
t &-QAO # oF
STORIEs:
L
rs Any ELEcrRrcAL, PLUIiBTNG
or fiEcHrlNtcrrr-
Nork Being oone to the Accessory structu.e?
[ ves [ ruo
rf the project
is a Relocation,
is there a Natural Gas Line on
the current site? f]ves I uo
Is there Electnica] power on this Building?ffiVes I f,fo
PRoPERW
tlsE
/ ocaJpAircyr
ffi
DESCRIPTION OF hIOR(:
DlsctAAlER lhe{aby
conjt ,Etall hbmrton h lris spplcaton i6
coflrctsfld allvorkvdl.omply$/ih tlc StrE aibing Codo €nd alt os.o. appticsbto
Slrb rd b..l lrrs
and odinanc€s and rEgulslions. Th€ NHC DolgloPln€nr
Solvics C€nEr udllbs notl5ed of any chang€s
h th6 apprcy€d plsn6 and Cscifc€ions or ci6n9s h contacbr orcont'€olcr inbrm€lim. -NoTEl Any wo* P€.bnfl€d wr'o tle App,oprisb P€rmiGwtt b€ in Vrolrtion
oftle Nc SEb Edg codc snd
&rti6ct t Fin€s (+ To
$ooc\ocrn
ONNER/CONTMCTOR:SIGMTURE:
*************+*************(Iill liI1**********++**++*:i*** ***,r******i. *+r**:rr* !r+**:r++* * *:r + ++
rs rHE pRopERw LoCATED
rN A rlOOOpUrHl
l-l Ves ffi ru
EXISTI}IG IMPERVIOUS
AREA: f) SO FT TOTAL ACRES DISTURBED:
NEIll IJ4PERWOUS
AREA: 17
OO SQ FT
EGST LAIO DISTURBII'IG PERITTT:
I-'] YES
I_1 ruO
MTER: ( cFpuA
f] comlururw svsreN
I pRrvATE wELL
I cen-rRal uer-l
sEhrER:
ELcFpuA
I ceHrnnl
senr:c
I pRrvATE sEpTrc
I cc|wrulrrrv svsrel,l
umc)m
mo
C6'
19
@
PER
IT FEE:
S--
lrarlE: ClnuL
Cofiient:
Citv lnspeclon Reqlreo, gl S254-0901
'*' sEPAaarE
PEnxrrs REgurtED FoR
ELEcrr ttEctt, pLaG, GA9
Equrp, pREFAas & $6ERTS ..*
pay.Er.rr ItErHoo:
I casr
f] cxecx (pAvABLE
ro u*: E rr..
*.-,ii 'E;;;-- n;.**.*
- /-.. (rof, orFtcE ust orly)
. r, ?-l5r.r.r*, Q(+kt)) "I#ri..r] ?,'so'
AppnovaL
:_ Ctty:_ D|ATE:q.ZE-l
5 FLOOD:
, REVISED oATE
O4lrrlu
RHr\.d--
e: Z6'
I X-- BFE+z?t=
N
HEt^l
HANOVER COUNTY
BUILDING PERMIT
APPLIcAfiffi rypE: RESfDENTIAL
PLEASE AilSUER
ALt QUESTronS AppLIcABLE TO YOUR PROIECT
'Project Responsibility"
APPLICAI{T'S I{,U'IE:
DEVELOPER:
UcKee Homes IJLC
PHO}IE
*:
PR0IECT ADDRESS: 1aT6
Eagtbourae prive CIW: llilminqton
suBDrvrsrol{: Eanover
ReEeE!.e _ Blocl(
#: Lor #:
PROPERW OhINER,S
ItIArtlE:
ilcree Ho&es
LLc Pll0f{E
#: 910-47s-7100
otilI*ER'S
ADDRESS:
1g!_Eer__St_CfTY: Favettevil]-e 5T: }Ic , ZIP: 28401
ST:g_ ZIP:
.3@
f:910-47s-?1oo
COHIRACTOR: 6rirr,
Development
Inc LICEHSE
#: 639?o
ADDflESS: 101 Hay
st
El,lAIL ADDRESSI wbynum8mckeehomesnc.com
CfTY: Fayettevitle
PHONE
FROIECT
c0hITAcT PERS0ltl: Keanv
Jones pHoHE
*: 919-3491381s
DCrsrrNG
cot{srRucrroN:
I ALTERATToN
I nrruovarroN
I eerurntl REpATRS
I ReloarroH
HEt{
coltlsrRucrroH: EI enecr ilEH REsrDENce
or
I ADDrrroN To Exrsrrr{G REsrrEt{cE
**PLEASE CHECT
AiID AI{S!{ER BELOH
ALL THAT APPLY TO YOUR PRO]ECT:
E]nrr GARAGE
4oz sF f] oEr GARAcE
sF EJPoRcH
lll_sFf] surunoom
_sFI aneennousr
TOTAL HEATEB
ff sronnor sHED
_ sF
SQ FT:
23s.t TOTAL SQ
FT UTIDER
ROOF: zssa TOTAL AREA SQ FT: :aez
T0TAL PROJECT C0STltessr-oe
: $ rsrgs:
f OF STGRIES:
:
Is Any ELECTRTCAL, PLlrl,lEIttG
or Ii{ECHAttIcAL
l*ork Being oone
to the Accessory stnucture?
[ ves E torf the project
is a Relocation,
is there a Natural Gas Line on the current
sitel fl ves fi ruoIs there
Electrical power on
this Buitding?
ftves Elnro
PROpERTY
UsE
/ occupArrlcy:
[l srrualr FAf'rrLy
I ourr-rx flromrouse
DEscRrPTroN oF
tJ0f,l{:
co*=rro"t "i*ol* f*ir, hor.
f"* dlqt *o
fini*h*d h*-
Dlscl.A,l]tE*lheEbycenifyhafallinformationinhisapplicglion.bcoItEctdldallv,orkwi,lcDmpIv
*#::::Xlfr.'#.t::.Y9"?Y"f:T:,*i,:".*_c"""' wlrl bB norine-d
oranycnanles in *ie epprowd preis
aJ specincarons
orcnarqe in conr.cbrorcontracbr
inb,maion.'-ilorE:Anvwork turbrmedwrcr t'eApp'opriae p."',e*irrLl"'G;d;;;;; NJG;
d;ilofl]"tr;E:fi;"::Li#: &ffi;ji
OI{I{ER/COilTRACTOR: wirl.iam
F. BynurrSIGNATURE: Wi[iamBynum
***'k***,t***,*+*:i+*:*'r,r*,F****#f{ifllq}********,t!r****,t *******+**+*,r********:},F,}:r*****!r*******
rs rHE pRopERTy LOCATED
rff A FLqXlpLArr?
ftr ves EI uo
Exrsr LA!*D DrsruRBfi{G pERi{rr: [-f vrs 3T{ Ho
wATER:
[l crnua
fl cour,rir,rrw sysrEFl fJnnrvare urru f, crrrnal wrll
SEtrtER:
EI crrua
I crrurnar-
sEprrc
I cnrvnre
sEprrc ffco*ru*rry sysrcu
*e* SEPAI&&TE
PEft,'qIrS ftEQUIREP FOft ELtrCT, tr{lCti! pL&6, G&S
EeUIp* pfiFfAB$ & IH$!ffi?S r**
pAyr{E}rr FrErHoD;
E*" Ecxeo< (pAyABrE
* *n
l ftnr.*r.* ;;;=;, Effi;;;"''"trDrscovEn+*tt* ***,t+** ***!r:tr+* ***,*:i,tra.*
****+** **** **** **
***:t***++ *,t,t*
**:i * ****,t*,t **:**,tr*ri
*,t** ++rt * ***:i *,r
(FOn oFFrcE usE ot{LY)
SETBACKS: F:
Apprcval:_ City;_ DATE:_ FL0OD;
Corr€nt:
5F
fJ eoor-
_ sF
florcr .- sF0THER: _ SF
ExISTIltr I|4PERVIOUS AREA:
_Sq fr
NEll II{PERVIOUS
AREA: SQ Fr
ZONE:
--
OFFICER:
TOTAL SCEES DISTURBED:
LH: RH; B:
REYISEO
DATE O1IL1,IL2
BFE+2ft=
I
PEB'IIT SEE:
$_
"&(*&o3?ots:LqqG
APPLICATIOITI
llunber
(Offtcc Use)
DATE:-
ZIPi 2a4tL
92
?rlr5- 8qq8 1s- 2593
NEI^I HANOVER COUNTY BUILDING PERMIT
APPLICATION TYPE : RESIDENTIAL
PLEASE ANSWER ALL QUESTIONS APPLICABLE TO YOUR PRO]ECT
"Project ResPonsibilitY"
APPLICATION
Number
(office Use)
DATE: B/21/75APPLICANT'S l',lA}lE:
DEVELOPER:
D.R. Horton, Inc
PHONE #:
PROIECT ADDRESS: s86 steele
SUBDIVISION: rhe Reserve at West Bay 62'
CITY: wilminqton ZIP. 28417
BLOCK f:
PHONE
LOT #: 54
#: aa3-6a6-2318
ST: qzTP,. 2e519
PROPERTY OWNER'S
OWNER'S ADDRESS:
IIIAIUIE: D.R. Horton, rnc
4073 Bel-Ie Terre Blvd.CITY: Myrtle Beach
CONTRACTOR: D.R. Horton, rnc
ADDRESS:
4073 Belle Terre BIvd
EMAIL ADDRESS: pCBatderoseGdrhorton .
com
LICENSE #: 2e61 6ACCOUNT #:
CITY: Mvrtle Beach
ST:gzIPi 2951e
#: aqz-aqa-zztePHONE
PROIECT CONTACT PERSON! Phillip Balderose
I arr GARAGE
tr
tr
TOTAL PROI ECT COST (t-ess t-ot)
Is Any ELECTRICAL, PLUmBING or
PHONE #: 843-616-2318
: $ r::,oqo
MECHANICAL Work
ALL THAT APPLY TO YOUR PRO]ECT:
-SF
SF
TOTALAREA SQ FT: ztgz
# OF STORIES: r
Being Done to the Accessory Structure?
fi V"t E
'lo
sQ FT
3308 sQ FT
NO
ACRES DISTURBED:
LAND DISTURBINGYES
[FI ruo
TOTAL
EXIST
15
PERMIT t [*l
SEWER:
I crnun
! crr'rrnnl sEprrc
I enrvnrE
sEprrc
I commullrry sysrEM
(FOR OFFICE UsE ONLY)
SETBACKS: F:
r^rATER,
I creua
I comNururry sysrEM
! enrvarr wrrl ! crr,rrnnL uJELL
ZONE:OF FICER:
*** SEPARATE PERMITS REQUIRED FOR ELECT, MECH, PLBG, GAS EQUIP, PREFABS & INSERTS **'I'
*1',|].I=-',.11',;...H.'1.1F-T:'l.l:111'-'.',.X.1i'.,-.H:l:'.l'fflIl...H[iy1l...-.tr-'.'.1':I:1.
REVISED DATE O4/L7/72
RH:_ B:_
BFE+2ft=
EXTSTTNG CONSTRUCTTOU:
! ALTERATTON
! nrruOVnrrOU
! CrrrrenAl REPATRS
f] nrlocnrroru
NEW CONSTRUCTTON:
E rneCr NEhr RESTDENCE or ! AOOTTTON TO EXTSTTNG RESTDENCE
**PLEASE CHECK
E oer GARAGE sF
E PoRcH
LSF
SUNROOMSF
! eoor-
_ sF
I sronncr sHeo
GR E ENHOUS ESF
! oecrSF OTHER:
TOTAL HEATED SQ FT: zo:z TOTAL SQ FT UNDER ROOFz ztgz
If the pnoject
is a Rel-ocation, is there a Natural Gas Line on the Cunnent Site? [ v"t E ruo
rs there Electrical Powen on this Building?
ll]ves E to
pRopERTy usE
/ occUpANCy:
@ srrrrcr-r FAMTLY
! ouer-rx
f] rowlrHouse
DESCRIPTION
OF tdORK: Sinqle Eamilv Residential
and ordinances and regulations. The NHC Development Services Center will be notlied of any changes in he approved plans and specifications or change in
contractor or
contacbr information. '"-NOTE: Any Work Performed W/O
he Appropriate Permits will be in Violation of the NC State Bldg Code and Subject b Fines Up To $500.00...
O[^INER/CONTRACTOR: phil B. D.p..Hortcn, rncSIGNATURE:
(Print Name)
* * * * * * * * * * * * t * * * * * * * * * * * ,k
* * * r. *. r. * r(
* * r. t( * * * * * * X
* * * X * * * {. * * * * * * * * * * * i( r. * r. * * {. {< * {. * r. * r. r. r. * r. X X * * r. r. *
IS THE PROPERTY LOCATED
IN A FLOODPLAIN}
JI VES
EXISTING IMPERVIOUS AREA:
NEI,'I IMPERVIOUS AREA:
AND ANSWER BELOW
495 sF
Appnoval:
City:_ DATE :F LOOD:
LH:
NUq_
.:.5 ;. l\,..NEI^J HANOVER COUNTY
BUILDING PERMIT
APPLICATIOI,I
IYPE: RESIDENTIAL
PTEASE AIISIIER
ALL QUESTIOI'IS APPLICABLE TO YOUR PRO]ECT
"Project Responsibility"
BLOCK #:
CITY:
LICENSE#;
CITY:
APPLICANT ' S
DEVELOPER:
PRO]ECT ADORESS:
SUBDIVISION:
PROPERTY oI4,NER'S
OWNER'S ADDRESS:
CONTRACTOR:
ADDRESS:
*:
LOT
t.lAIlIE:Zc
D
EiIAIL ADDRESS:
PRO]ECT CONTACT PERSON:
\c
**PLEASE CHECK AND ANSI,JER
! arr eamcr
Srrr*oo* /"76 sr
I cnrrnuousr SF SFOTHE R:
SF
SF
let s-}stt
?o\5 - {ooa
z,Pt Z<1/o(/o--
PHoNE
*: 6z-z--oti1*
srt U?z:,P,:Z-st({
sr:lQzrr: aL-VbS
PHONE
PHONE
DATE:
APPLICATION
Number
siG
?1q-7 t 1 -?
__L
ExrsTrNG CoNSTRUCTTON: $ ar-rrnarroru
! nenovarroru
fl ortenal nrearns
! RELocarroN
NEIJ CONSTRUCTIOru:
! enrCr NEr,l RESIDENCE
o" ! aOOrrrOt TO EXISTING RESIDENCE
BELOW ALL THAT APPLY TO YOURPRO]ECT:
sF I oer canace
sr
! eoncn
-sF
! eoor-
! orcr
SF
I sronncr sxro
rorAL HEATED sa n: l 'fu
ToTAL sQ FT UNDER
aoor, / 76
ToTAL AREA
sq fi, /'76
rorAL pRorEcr cosrlressrorr
,53359..;', f o, ,ro*r-r, 1-_
Is Any EI-ECTRICAL, PLUiIBING
or IiIECHAIIICAL tJork Being Done
to the O..urro"r
*I*"", fi V", [ ruo
If the project
is a Relocation,
is thene
a N?tunal Gas Line on the cunrent
sitel I ves I no
Is there Electrical powen on this Buitding? flv"t E ruo/
PROPERTY USE
/ OCCUpAi,tCy:
[lSrtCr-r rmrlv ! ouclrx ! TowNHousE
OESCRIPTION OF WORK:
r {l t21 a,"dL.
DISCLAIMER: hereby cerrify liar all in his applicalion is correcl and all work will comply wih lhe Stale Building Code and att oher appticable Siaie and tocat taws
NEW Ir4PERvIoUs AREA:
_ sQ Fr Exrsr LAND DT5TURBTNG
rrnmrr:l [!ffis I r,ro
* )*** * ** )*,*
* ,* )*** r*:*
)*x* )**r*
** )r )*
*,**)* *,t* )t*
** )**+* **** * )k*
*:i** ** ** *** * !t* )k r* )* r*ri
**** )*:* )t
**** * )*** +* )t*
*+
OF FICE R:
(FOR OFTICE USE OTLY) REVISED OATE
O4l11l12
SETBACKS: F: LH: RH: B:
Approval:BF
E+2ft=
N
PERMIT
FEE: $
,t,*
++:i**,i +** )*,r * * *** *
*** ** *
* *(Ii'I i J311** * * * * ** * * )k*)r * t +:* +*x+ * ++ ** )r )rr )**
*,** )* )r )*** *,* jr,r ** *:*
**,r)*,**
rs rHE pRopERry LocATED rN a rlooonlarrr
ft vrs f;_ro _ --.l r
ExrsrrNc rupERvrolrs AREA:
-sQ
Filo{oi o.*r, DrsruRBED: REGF"I-H
wArER:dcFpuA
E.o*r,Irr svsrrm
! pRrvArE ,ELL
;.r;;-^.-';r; H
-ige*'e
oIz0ts
sE!,rER: EcFpuA I crHrnar
srerrc
! pRrvATE sEprrc
I cour,rururw svsrrm
*** SEPARATE PERI,4ITS REQUIRED FOR ELECT, iIECHJ PLBG' 6A5 EQUIP' PREFABS &
pAYfiEr,rT T4ETHOD:
I CaS'r
ICXEC( (PAYABLE
rO nrCl I anearcAN ExpREss
E ra.
and ordinances and regulalions The NHC Developmeni S€rvices Center wrllbe noiilied ofanychanges in he approved ptanllnd specifications orchange in contractor or
ZONE :
Comment:
' Citv: DATE:FLOOD:
SIGNATURE:OIdNER/CONTRACTOR :
D\5- q 0
os
la,
7
Z {S-?STS
NEhJ HANOVER COUNTY BUILDING PERIIIIT
APPLICAII(N TYPE: RESIDENTIAL
PTEASE ANSI.IER ALL QUESTIONS APPLICABLT TO Yo(JR PROJECT
"Project Responsibility''
l{AllE: Anthony & Susan l,ioy
30 Robert E Lee Dr
CITY: Wi lmington
APPLICATIO{
t{r.mber
(offtce Use)
DAIE: 9-8-201sAPPI.ICAIiIT ' S Ml{E: Art Davis Construction .Lnc.
DE,EL.PER:
N/A PtloI'lE
PROJECT ADORESS: ?O Robeerr l.r l,ee l)rive CITY: wilminqton
#:
ZIP:28412
SUBDIWSIOI{: Pine val I
ey BLOCK *: LOT #: ]qL
PNOPERTY ff{ER'S
OI.IER'S ADDRESS:
Pto E *: 970-36 t-2204
COffnmldfl f Art Davis consLruct-ion roc
ADORES3: rl0 t
,o r'rq. , eL.
Eidlt AdRESS: arLGarLdavisconsL.com
LICET{SE *: 64667
sT:qzIP:28412
ST: NC ZIP: 28451
#: 910-612-6596
CITY: Le Iand
PROIECT COTTACT PERSOI{: Art Davis
pHot{ E
PtlOIrlE f
: 910-612-6s96
SF
SF
SQ FT:
TOTAL PROIECT COST lress ro9 : $ $trs,ooo.r,--._--.---_-.Is Anv {ELECTRICAL. PLU BIIG or TIECHA ICh HorK
If the pnoject
is a Relocation, is there a
s OF STORIES: 1
Being Done to the Accessor y
Natural Gas Line on the
AREA
p
structure?
[ Yes
Curnent Site? [
Nro
Yes E No
n room into liwi ce 266
TOTAL
EXIST
I comrurrrv svsrrm
! pRrvArE wELL
fl crurnal werr
I cenrnnl seerrc
I pRrvATE sEprrc
! comrultw svsrem
NO
ACRES DISTURBED:
LAND DISTURBING
Code ahd al oher appticable Slab a.d bcal laws
'ld sp€cificalbns or change in contEcbr or
!c Fjnes up To
$500.00"'
vrs
l-'l rc
4,
000 sQ FT
r24s sQ FT
N/A
PERI,IIT:
rl
casx flcxecx (pAyaBLE
ro nxc) l-''lmrrucA ExpREssl,lclvIsA DTSCOVER
* )* )t )t + ** **** *;r:t* +** + +* * * *rt,t,tt*t *{r{!,t*** ** *,t *,t*)t t*t **** * rB*rr )r)**
*** *,t*** * ,*,*,} )t*,},}*** **** ***,} **
(FOR OfFICE UsE oNrY)
SETBACKS: F:RH: B:
REWSED DAIE
0./t/12
t 'tlsre+zft= \ ,r'
ZONE:
N
Exrslrt{G colsrRucrroN:
! arrrnlrroN @ nrruovarroru
! ceruenar ntelrns
! RELocATToN
NEr{
col{stilltTror:
I enecr EU REsTDENcE
o"
lZ morrroru ro Exrsrrrc RESTDENcE
**pr-elsl cHEcK Ar{D At{sr{ER BELor{ALL THAT APPLY TO YOT,RPRO]ECT:
TOTAL HEATED
SQ FT: 1311TOTAL SQ FT
U DER ROOF: 131rTOTAL
tr
tr
rs there Electnical Power
on this Building?
lElves l-'l Ho
sq. ft. remodel existing closet and master bathroom and laund112 so- ft-
PROPERTY USE
/ OCCUPAI|CY r @ SrUCre ramrrV
[ runr-eX
! TOhTNHOUSE
DESCRIPTIq{ OF I|ORK: New
addition 1,045
sq. ft., re-build exi
DEaIAER I hereby cemfy har an inbmalion in his +plcalon is
corccl and a! wo.t wil comply witr he
and odhancos End rEgulslbns. The NHC Development Sorvices Centsr willb€ nolfied ofanychanges in he
conuactrr intoImalion. '-]{OTE: Any Work Perfonned W/O tne Appropriats Permits willbe in Violaiion of the NC
OIT{ERICOI{TRACTOR:
AET D
hJi< SIGMTURE:
IS THE PROPERTY LOCATED II{ A FLOODPLAIN?
r...l YES E
EXISTIiE UPERYI(I'S A,REA:
NEH I'iPERYIq'S AREA:
MTER:
E CFPUA
srwrn:
fl crRua
**i s
PAY}IEIT iET}OO:
fl nrr eanaee
L- sF
! oer canaee g
sr
fl eoncn
-
sF
suNRootl 0
tr P@L O
5F
! sronaee sHED
-
sF
GREENHOTJSE O SF
loecr L sFOTHER: 104
5 + 266
(Prtnt irane)
Approval:
OF FICE R:
OATE:FLOOD:
LH:
?otr- 1oo ul
ir as+g
APPLICATION
Number
(offi* U*)
PH}NE *t?/0 -200 -3N5si'Mzrp@/
LICENS
CITY:
NEW HANOVER COUNTY BUILDING PERMIT
APPLIcArIott rvPE; RESIDENTIAL MOBILE HOME
PLEASE PRINT CLEARLY & ANS}IER ALT QUESTIONS
"Project Responsibility"
APPLICANT,S NAI{E:
DEVELOPER:
PRO]ECT ADDRESS:
SUBOIVISION:
MI'iE:
rtrL
CONTRACTOR:
ADDRESS:
EF,IAIL
PRO]ECT CONTACT PERSON:
DESCRIPTION OF
'.ztPt)7fJ4
b- ru-n5>-
c-
PHONE
PHONE
sERrat *:
/i
COLOR:
5F
SF
(FOR OFFICE USE ONLY)
SETBACKS: F:
REVISED 4/12/17
B:_
BF E+2ft=
a
rrt-)tr
mo
r?r.E
o
<C'
e
OFFICER:
Approval:
comment:
N
PERMIT FEE: $
BLOCK #:
PROPERry o!'lNERr S
OhINER,S ADDRESS:
N EI,J I.,1OBI LE
(CHECK ALL THAT APPLY)
HoME gt'rroaorrot oF usED MoBTLE HoME
wilb.inviol5tio.ortheNcsd.Bld9cod.{dsubj6ctbFiBUPTot500'00..*o,u*,,./ln4
owNER/CONrRACrss, ,<lh
fhrn(rlrvl- src
(P.int Naie )
)*
* )** *,* + + + + + t )t:l * )i,i )i )i
* * )t,| + ****)i* * ****+1**.+1**** ***)* * * '*
)*,***)t*'f* )t*+*'t '** * )i
* )t 't )t 'f +++*'*)**'*xx*****
rs rHE pRopERw LocarEo rN 4 FLooDPLATN?
[ ves @ r'rq-
pRopERTy usE/occuPANcY:
ffnesrorrucr / orHERl sioN
HUD LABE L:
YEAR TIADE:
HURRTCANE zoNE:
I lilzZ3 s]loKE orrecronr B/ws I Ho
,.
GARAGE:
E ves Btruo
l'/
ToTAL AcREs otsTURsED t ,/4 ,/
Exrsr LAND orsruRerNcleifr;;;l-'i ves
ffrrro
TOTAL PROIECT COST (Less
Lot): $
MANUFACTURER:, Z8' -LENcri,-T
wArER:
! creue
I CoMHUNTTY sYsrEM
sEhrER:
! creul ! CENTRAL sEPTrc
drrrroru wprr I--l cENTRAL wELL
ffi** o'r, seerrc-fl cour"ruNrry sysrEM
Iii!* SEPARATE PERI'lITs REQUIREO FOR ELECT, }IECH, PLBG, GAs EQUIP, PREFABS & INSERTS J**
pAyrlEr,rr
irETHoD:
E casH I orecx (PAYABLE
ro NHc) [ erlt nccouNr
I ucTvrsn I orscovtn
ZONE :
City :DATE:_ FLOOD:
LH:RH:
uL
APPLICANT'S NAlllE ;
DEVELOPER:
PROPERTY Oh'NER, S
OtrlNER'S ADDRESS:
NEt^l HANOVER COUNTY BUILDING PERMIT
APPLICATIOT,I IYPE: RESIDENTIAL
PLEASE ANSWER ALL QUESIIONS APPLICAELE TO YOUR PRO]ECT
"Project Responsibility"
'ennr.ff R.6":t
LOT *:
CONTRACTOR:
ADDRESS:
PHONE
lto '7zz /2 3f
ST:
-zrP:26?af
ZTP ,.
PRO]ECT CONTACT PERSON:
PHONE
PHONE
ST
#:
*i
I eoor
-
sr ! sroRacr,*.11s9
-
sF
!oecr
-
sr j^r^, 11""*-ZJl+uSr
fuo 1 Tnr^r ADEA <^
toat
FT: 7-oo L
No
Eruo
** ** * * * * *** ** ** ** * * |,8* *+ * +*** * r, )t)t
i +,*tr *** * * ** ** * i< *,t* + + tr(,t * **,* ** )** * **
IS THE PROPERTY LOCATED IN AYEs
E rvo
TOTAL
EXIST
EXISTIM IMPERVIOUS AREA:
NEh' IMPERVIOUS AREA:
SQ FT
SQ FT
ACRES DISTURBED:
LAND DT5TURBTNG pERr,lrr: E VeS l-'l ruo
BF E+2ft=
_-/
warra
7 crpun
E coMl4uNrry svsrrm
! PRTvATE wELL
! crrurnal wrrr
sEwER,t- cFpuA
E arrr*, sro-rc finrvarE sEprrc
f]- aorrrrrr, ,rrrrt,t7*** SEPARATE PERI,IITS REQUIRED FOR ELECT, IVIECH, PLBG, GAS EQUIP, PREFABS & INSERTS ***
pAylitEr,lr
ilErHoD:
Ecos, EcrrcK (PAYABLE
ro rxc) E ar,renrcAr{ ExPREss
E mclvrso
I orscoven
,**,** + *,*+,* + ++rt,* +,** * ** )*
** * * * )** r(,t* + **,* +* + **,*** **** *** )k* )i )t
**** *r(*ii *+
(FOR OFFICE UsE ONLY)
SETBACKS: F: LH: RH: B:
REVISED DATE O4l11l12
ZONE:
Approval:
OFFICER:
N
PERII,UT FEE: $
?4+t5 -2s1,4
PHONE
?ors- loo f
APPLICATION
Number
(office use)
DA'E: q
-7-/f
EXTSTTNG CONSTRUCTTON:
! nrrrnnrrOH
! nrNOVnrroru
fl<irurnaL necarns
! RELocATToN
NEW CONSTRUCTTOru:
! rnrCr NEb/ RESTDENCE o" ! AOOrrrOru TO EXTSTTNG RESTDENCE
**PLEASE CHECK AND ANSWER BELOW ALL THAT APPLY TO YOUR PRO]ECT:
! arr eamcrsF ! orr cnnncesr !eoncH
-sF
! surunoom
-
sF
! ene rruuousr
-
sF
-.^1TOTAL HEATED SQ FTi c'L'u -TOTAL SQ FT UNDER ROOF i 4U _ TOTAL AREA SQ
TOTAL PROIECT COST tress rorr : $6K #oFsroRrEs:
Is Any ELECTRICAL, PLU|IBING on flECHTNICAL l,,Jork Being Done
to the Accessory Structure? [ Ves I
If the project
is a Relocation, is thene a Natural 6as Line on the current Site?
E ves
rs there Electnical Power on this Building?f]v"t [ruo
pRopERTy usE
/ occupANcy,
ffirncrr rnrlrrv
I ouerrx
! TolJNHouSE
DESCRIPTION OF WORK:;4€ r,-/'oOrtn- O
/e. a
DISCLAIMER: he eby ce t that alwillcomplywih ihe Stale Building Code aod 6lloher
and ord nances and reg!la1ons. The NHCanychanges in the appro,"€d plans and
conlractor mformairon. "'NOTE: Any Work in violalion offie NC StaE Bldg
OtdNER/CONTRACTOR:SIGNATURE:
Comment :
City:_ DATE:FLOOD:
/..1
PRO]ECT ADDRESS:
SUBDIVISION:
EtrlAIL ADDRESS:
CITY:
LICENSE #:
CITY:
NEId HANOVER COUNTY BUILDTNG PERfqIT
APPLICATI0F| TYPE:
RESfDENTfAL
pttASE AflStiER AtL QUESITOHS AppLrffBL[ I0 yoUR pfo]ECT
\, "ProJect Responsibility"
€rt iL{5'"/a
CITY:,i a"/
*, 7t*, ,/rI ! e gf
Sr:
-Zt?:'4*a"f'
STr
_ ZIP:
_*-
?ots-qoo{
APPLICATION
l,luinber
(offlce U5e)
-q-t$
rfC
ffir'.iQ E!r.
i' -.- titi "'-
APPLICANT'5
DEVELOPER I
PRO]ECT ADDRESS:
SUSDIVISIONl
PR0PERTY 0lil'lER'S
ONNER'5 ADDRESS:
CONTIIACTOR:
ADI}RESS:
EMIL ADDTESS:
PRO]ECT CONTACT PERSON:
t'y'.'
/7 ff<:.:
PIENE #r
PHON8 S;
€xr5TrN6 CONSTRUCTTON:
I AlrrnnrtOru
[ nrHOVAEOr,r
fl<firrnar- REpAIR5
[ nrlocnrrou
NEIJ cONSrRr.'CTrONr
I ERECT NEI.J RtSTDEtiCE o"
f, aOortroN ro EXrsIrNG RE5TDENCE
"NPLEASE CHECK At'A ANS}'EN EEIOW ALL THAT APPLY TO YOUR PRO]E(TI
f] nir GAMGE -- sr n orr 6ARA6E sF
fJ PoRcH
-
sF
f] suirnoom
*.--- sF
I anrrrvHousE
-
sF
T0Tr\L HEATED SQ FT: Lq !
T0TAL PRO:IECT CO$T{L-essr,or) ; $6 K # oF sroRrES: --Is Any ETECTRT(AL, pLUI{BING
or nECHANICAL kbnk Being Done to the Accessory Structuret
fi Ves
fr fVo
If tlre project
is a Relocation, is th€re a Natural Gas Line on the Current Site?
fl Ves
E ruo
rs there Electrical Power on thls Building?
ff v"t ff u,
PR#ERTY usE
/ OccuPAtlcv;
El6rNGLE rAilrLY
fJ ourlex
f] rownmuse
DESCRIPIION OF ca{l' .€fOcrtn- {) rC r
l slfl conlory blil)
h6 Stere Bundhu C+,Je ar0 6s oaer hDfllcrrl,€ StCte
f] nooL
-"--- sF f] sronnee,,sHED
.. sr
f oecx
-
sF Enu*, K'"'*''*'rqof, 2tt't
?,J+
- ToTAL 5Q FT UNDER ROOF.
"?CI *- TOTAL AREA 5Q Fr: Lot' ''
DISCLAIMER llrcfftJyesrl]{v [rBl ]I irhr
a.d odroan{:es Dnd reoulatbns. I
he NHC soycnsnges in ult apptoqtJ Plans ai'd
co8vaclor intofiration. "'NOTE: Any Work'n
Vtclalsf cI sB NC SlrE BkJg 946f std
OICIJER/(ONTRACTOR:SIGNATURE:
* *
**ir* * ****x** * o*** f*"**r** JIIU*{
u ll{_
+ I ** * + + * * * ** f + *
* * * * t a* ***** +;* * * * * *(*' +:t +* *(
iS THE PROPERTY LOCATED IiI A FLOODPLAYEs
fl ruo
SXISTIHG ITIPERVIoUS AREA:
-SQ
FT TOTAL ACRES DISTURBEO;
1'o
*':y'*u'TAREA:
.--.-sQ FI Exrsr LAm H|f1ffirufffiffle$ffi.l?1ffid$ytru
T,JATER:.ffi creua
f colu.rururrY sYsrEM
fJenrvarr we u f crurnal wrlL
-cEr.JER:[y'crcun
f] crtrn*l sEPrrc
fJ enrvare sEPTrc
I comNtrurw sYsrEFt
N,T
'EPAf,AfE
PEftI,1ITS RrQI]IRTO FOR ELECT,
',IECH,
PI.B6) CAS TqJIP, PREFAES & lNSERTS {"*
pAyrrlEMT
rriEr*oD:
fJ cosn
fi cxrcx (pAvABLE
ro ilHc) fJnmrnrcm ExpREss
t ,clvrso fl orscovrn
*,|.* r +
** $y y
*
r $i v * **+" ** ***t r * * * f *+ x * *+ x
r ** r+ +* +*f *+ ** f,* $+** i x tt + + + +*
+f + {,+ )t * * * ** * *
** * * * *
**
.o*r' Q-tf 0FFrcEB:
?.i ,i'ltT;:-;: T:ht rN:
bri{f RH:
wr,w:itvlr''
0^rr o4/'1r'/1'j
Apnroval:-city: ?rorun DNEtqlul€ FLooD:
-;- -;* +- BFE+2rt=
Pg+ tS "zu1v.
Pl"fl}NE
BLOC(
't
,t
rl:fl
1
?nd;E
PERFIIT FtE: $Comnrent:
Iw,
PH0t'lE fl
LICEIISE #:
CITY:
DATE;
uurr$"-1
APPLICANTJS
MflE:
DEVELOPER:
NEtd HANOVER COUNTY
BUILDING PERMIT
APPLICATI@'I
ryPE: RESIDENTIAL
PLEASE ANSWER
ALL QUESIIONS APPLICABLE TO YOUR PRO]ECT
"Project Responsibility"
5-l z*= Z3:?-/8"82
)/,k8.*
D<, crTY I
//tt.ttt.ot; rz,w
BLOCK #:
PRO]ECT ADDRESS:
SUBDIVISION:
/,t// 1 ,7 /.?
€'i,/*
ztP I Z
7/a?
LOT
*:
PHONE
*, GtD rsz- 8o ?e
srt::!zrPt 27tu,
sri
4zrP,: Z8'/zz ,t*: 7i?'29t-//81
ploNE
#: //?-rjf-8o?Z
PROPERTY OI,/NER, S
OWNER'S ADDRESS:
NAME
'Lf,,z LICENSE #:
CITY: /.r'/Z,7?/.r/472",/
PHONE
PRO]ECT CONTACT PERSON:
EXTSTTNG CONSTRUCTTON:
! nlrrRarrOru
[] neNOVnrrOU
! erruenal nrcarns
! RELocArroN
NEW CONSTRUCTION:
! rnrCr NEr./ RESIDENCE o" I nOOrrrOru TO EXISTING RESIDENCE
**PLEASE CHECK
! nrr eamcr
I surnoom
-
sF
! cRrrruous r SF
TOTAL HEATED SQ FT:
AND ANSWERBELOI,I ALL THAT APPLY TO YOUR PRO]ECT:
sF ! orr
canace sr
! eoncu
! eoor-
-
sr
Soecx /2 sr
SF
! sronacr sHED
_
OTHE R:
TOTAL AREA SQ FT:
TOTA| PROIECT COST,r.*r^r, : $ 7( act,19 # OF STORIES:
Is Any ELECTRICAL, PLUIIBING or I,IECHAiIICAL l,Jork Being Done
to the Accessory Structurel ffVat fi
If the project is a Relocation, is there a Natural 6as Line on the current Site? [ ves
Is thene Electrical Powen on this Buitding? pl'v"t I r,ro
pRopERTy usE
/ occupANcy ,,
{rr"oG rnmrlv
! ouelrx
I TowNHousE
SF
SF
TOTAL 5Q FT UNDER ROOF:
No
wG
Ez
w)rto
Xots'$oo7
APPLICATION
Number
(Office Use)
oe'., z/f s-
*t 29/ -//8/
eac-rt0
PHONE
lzte f,filcaz-
zr?e".t;.z;
%;zarrv
DESCRIPTION OF [,'JORK:
DISCLAIMER: lherebyceniry ihai all nformalion in this applicaiion ls
EXISTING IMPERVIOUS AREA:
_SQ FT
NEW Ii'IPERVIOUS AREA:
_SQ FT
ZONE:
OFFICER:
Appnoval:
€n,",2 ( / t
/.1/,t//,1/'.r'(V
' -/a D € '/1'€;? 0.47-{ ,24'-7zP 447-/ 4?{4. Et4,ltF *7. "4.1,p
and all work will comply wih lhe Slate Building Code and all olher applicable Slate and local laws
contactor inb rmaiion.
"'NOTE: Any Work PerformerUl,l}hg Appropl aE Perm ris w l be in Vo lalion of ihe N
C StaE adg Code and Su bject io Fine s Up To $500.0Cr *
owNER/coNrRAcroR: f-78---<' srcNAtuae.z
)a*rs /a,11,;., r11//n-+t
{P.rnt Name)
,*++,t+ilFfl.*-++{.+++++++***+**++***)**,*)****)**)i)k**)****)t*)t)t**)t*)k)ttr(*)*)t
rs rHE pRopERTy LocarED rN r rlooormrrul
I vrs Ww
l,>n
TOTAL ACRES DISTURBED:
Exrsr LAND DrsruRBrNG ernmrr: I ves
l-'] ruo
wArER:
Ef cFpuA
! commururw svsrru
! pRrvArE l^lELL
! crnrnar wrrr
SEWER:
EfeFpuA fl crrurRal seerrc
! pRrvarE sEprrc
! comr.rururw svsrrm
*** SEPARATE PER},IITS REQUIRED FOR ELECT, MECH, PLBG, GAS EQUIP, PREFAES-' INSERTS ***
PAYT4ENT ETHoD:
I cos,
[ .rrcK (payABLE
ro ucl I arrnrcaN ExpREss
W^rnrro I orscorr*
** * r*
* ** * * * * ** *,* * *,** **,r ** * + )** )t*
** * *** * * *,t* * ** * *+,f r( *** {<* )t* * {< r( *,t* * )*,*
* * * * * * *** ***,* *,*** )*** )*
* *
(FOR OFFICE UsE ONLY)
SETBACKS: F:
REVISEO DATE O4l11/12
RH: B:LH:
BFE+2ft=
N
PERMIT FEE: $
and ordinances and regulations. The NHC Development Services Cenier willbe notfred ofany changes in ihe approved plans and specilicalions orchange in
contracbror
Comment :
City:DATE:FLOOD:
ETAIL ADDRESS:
CONTRACTOR:
ADDRESS:
HrcflvEDAtJ6$1mS
ITEW
HA VEN CO$ITY BUILO$S
/F;PLrc/.TIo,t rr?pf; CS&IERCIAI
{-)t t tPERI{rr' T0
5 ,* T*r
\S- tobrffi
Nunber
(OffLce Usc)
plEAsE A,{5TER
AtL SJEStt.I)}ts AppLIcASLc T0 yoffi pRolEcT
trProject Responsibltity,,
El,lAIL A00RESS
: qradvqgP$amahomee , net /bianca.euresdanehomeg , aet
PROJEC? C0il{TA€I PERSOH: .Efadrr cordon
If WFrT
- The shell pernit S:
Exrsr corlsr*trcrrotlr
f, ru-reRrrron
[ *t*li[*lii'liEi"*. BEpArRs
I ne'wnuo*
ll
Rcbcatlon,
k frere a Natuml
Gs una on rhe Cunent site?
fiv*-fl r,ro ts
sLoc S?RiNxLERED?
fl ves
fi No
t{Et{
c!ilsrn
crralr
[l EREcr
rlEt, srrueTURE
fi rlsr rnncx
fJ snrr.r.
fl wrn
ft ADo
r0 Exrsr srtucTURE
ACCCS5MY STRTICIURE:
APPLxCAI{T,9
WEt DATE: 81,FtU
lT!T'1: rylgms Eoftee,Llc .. - - .--, ..- plo6E
*: sr0-7e8-300s,,pRoJEcr AD0RESS:
,r3? lr*r"o ,r .. --- crry! r{tlnl]-nqron
.-. zrp: ?.8412 ,0CCUPAI{T/BI SII{ESS lrlAllE
: EeJ
lemeade-,*parurnenis _
fl::ly.g:l:s l{AltE! Bell'noade Deve}oprn€nt parlners.r,rrq.- - . pHottE
s: s10:?e-s-3q0.6 -0|$ER,S ADORTSS: -FGzE-c Gordqn
id _CITY: wilm{nouon ST:
wc ZIP:28{u
C0ffIIIACTOR: ucadamp Homeq,.I{I+C
tIcEilSE *r 3lgg1_ ACC0ItrtT
*:
ADDEESST 6J,A6-c Corcron Rd
CITY! wilminqr(}Ir
xF yei, uhat r,s nn.
,"liillT.:Xfi":rffiE oF oca'pAt{cY
t.tirFfr$,H llllr,.., ,r*,
AiCB DESI60{
PI0FESSIOI{
L: Fraah park
sfi6n DESf6il PR0FESSIOIUILt
DESCRIPTIOi] OF I{ORK:
Is Elect pouer on
thls Building frt ves ffruo
PH; NC RE6 #:
PH: NC ftEG
*;
.l'-.-. /1 r.'--.f ,rJ-
((I*., (anrtiD)fl&: Demfrr nsfltcdo'r!
t r$.ttt lont vd fotEt replbllgt}' ari o b. .ertrnltal urhg 0re apgrcatbn irrm (ollH$-3?0[l rtr0rar fra
lh@ or h{dhg ris {ou,id
b
ffiffiJTeH^ffi#Hffi,9"ffi* *ToTAL PRoJECT
Cosrr .;k a*u_ BUlt tllG HEtGt{T: I f '
b lbd or
baroragn* trapacd a amred kr
trb errrnro?
ff ves
fil r,ro tc Ttr properry tocatod tn
Tho
Ftoofrhh?
Clv*
E
\rnd sll olicr
&Icsblo Stat6
ffi,ffro"mr*,
OWI-IEIUGONIRAGTOB: Adam
EoEne . .,-.,,
-. $IGNATURE: CF,tt" ' *'"
TOTAL
Af,EA SO
"T
: ... lQb - - -
80 FT PER FLR:
-
f OF STORTESE-
TorAtseFruilD€R noor: iolq #oFsrRUsruRE--_ #oFFLooRs,
ll-l
ACHE$ DI$TURBED;E)Gr IAND D|STURB|NG pEnrur? E3W8 fJ No
NEW
IMPERVIOUSAREA:,
$QFT F(STINGIMPERVIOUSAREA;8Q FT
PRoPERTyt
Sr; f]oFFrcE
flnesm*mnrr fJuencrur'u"e
Deuuc Dnpr
floouoo ontEn:
WATER:
SETYER;
-" SEPARA]Epg{Mt"rsRE(xx[Eor:cn EtEgr, trtECH,pl-EG, (iAs Eoi..,tp. rREt'At}s & tNstBTS
".
mcFPu DoomtuNnysysrEit ErrrELL EIzoNr\rc(aEcLASficmre ficnnnnl.sEmc Diffivnre 6Epnc giloruuxrwsysrEu
DUc
flApr floouoo <rnun: L^rJ_l f ,
I -i
[fzoNr\re UgEc1ASSpcAno* ..f-
PAYrlEttr tilEftorr
flc sH
fi cneoc pnvnaLE ro Nrc)
fi atu ecco${T f}$cwlsn fl olscovrn
{FOROFFICE USEONLY}. EvtsEDDATG,.frrrr2
za$E;
Cfr -oFFrcER;SEIMCIG:F: hts Lt* :* RHl -a*z B: Ap
r<ruooo, - , flr]Effi-A v n N
PHONE
ST: Nc* ZIPt zs{11
#; glq-J,gg-:ooe
PliorIE
f: glo-36?-r223
Appora[,, txq1.--Lffi
PEBMIT FEg $
"\L(
NE'C[IVED STP OB TO15
trlo pr$+r)S
NEhJ HANOVER COUNTY BUTLDIIUG PERT4TT
APPLTCATIaN
TyPE: COiTIf,IERCIAL
Pr6A9E AUS|,IER
aLL QU€STrONS APPLICAELT T0 y0uR piloJEcT
..project Responsibllity',
frz rt- )tts1
?otT- 9 ot o
APPI.ICATION
Number
(Office Use)
APPLICAI{T)S ITJAflE:
cNE Hpme rmproveme}c
p&0lECT ADDR€SS: +az9
qaiversj.cv prjrePHONE
*:
CfTY: iqilmin-qtcnZIP:2e.1cl
OCCUPANT/BUSII.JESS FIAIiIE
:
PR@IRTY 0tdNER,S
MHE; FHONE
*r :]35_2.t4-?4si.0NNEA'S ADDRESS: t'400 BarLteqround_Aye. see_
2c1 CIfil creens!c3jt__-_- STI r,ic..-
ZIp: ??*.{0n
CONTRACTOR: CNE
Home fmDrovemenr.
rmert LxcrNsE #%:9.3.*:3jlsl ,rrnprovemenr LrcrNsE
#: 6err8 _ ACCoUNT
$:
ADDRESST "o il';;;'
rreJ'e - ^'"*''1,% crTy: .xinq . __ STI
lrc Zrp; z:o:rSTr
lrc ZIP; zrcz,
PRO]ECT CONTACI PERSON:PtloNI
S: ti6-3e3.0430
Exrsr coNsrRUCrroN;
n *reRnrroN m *#il;l# '[i3['i)Erol' nEpArRs
I nrrocar:0ru
if
Reloc€tion,isthoreaNatural GasLineonthecuirenrsite?
fiv* ffir.ro tsBLDGspfrilxlrnrozfiv", fllro
NEh,
coilsrRucrroN:
I EBEcr NEtil
srRUcruRE
n pnsr rnacx
f sHrlt
I unrrr
f] Aoo r0 Exrsr srRucruRE
ACCESSORY STRUCTURE
I .
EN6R OESIGN PROFESSIOI,IAL :
PH; . NC REG
#:
PH:-- NC R[6 #:
DESCRIpTION 0F I,JORK:
Interlor repairs due
t? snroker/fir.g._Carnaqe ,- -_ ,,
ts
tood or banemges prcpared or
sorv€d ln this stJucluror
fiv"r ffi r.ro h rho proporty Locared ln
The Floodplainr fJvos @ ruo
and local lrws anti
r., chp,lqc io
conua
oI$CLAIMER: I he:eby cGrdty
thai slt tn{orrnatiql in rhis applicetion is correct 8nd al!vrork fi,| comply wilh the
$aleanJ.Jocal laws
and ordinancet anrt reoulitions.-Ttre NiTc 5;;;'i;;il"r qard^o<..,rr- -dr r-, ^.,,:n;.rcr chEnQe io
cont actor or contrai'tr:r
subjeci tu Fines up To
$500.00-.
mai arl lnlor'naron in this apslicetion is corrett 8nd al!vrork fi,| comoly
wilh the
$ate Buildirrg
Q66" un6llll other apFtrcal),e
slare
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Slate Bldll Ccde.nd
OWI'{EFUCONTRACTOR: ctiE Hcmq rmp):ovenenL SIGNATURE:
{tllrXNsr)
flil,mmT.Y::iT:"-j*:j3,fl1liLryl,-11?r3i9:-Tl f :uyll:d urlns
ry glpricaron romr {DHHs\3708i v,rrc$sr rhB
raciiily or bdrdros was bund ioconlrln Asbostos or rot You arB requlrod
b call tha Notlonal ftnbslo0 standsirs trr Hazaruois AJr potuiliHil,ffi :ff flililJJrffi"ffiTff#',J$JtHff y,mX?l:tgfiy#,ffi #,#JffiBf Ifr
whffi
raffi ;x*:::"TOIAL PROJECT
COST:
i} 1000.00 BUILD|NG HEIGHT:_ ",_r,iiwYw
,]Yl tl?54"09ff]
*Wq{*, eln:g
TOTAL AREA
S8 FT :
-
SQ FT PER
FLR;#OF STORIES:rorAl se Fr UNDER
noor: _ r or
srnucruREs-_ ; &;iffi; -:.
SO FT EXI$TING IMPERVIOUS AREA.
PRopERryusE: floFRcE f]nrsrnumNr f,urnururrue fieouc
[mr f]ccruoo orHE*
ySE[; EBFEXI
EcB$lmtHffi't #.ffit*,,,,. nHffi]iliBysEClA$srFrcAroN:
". {iEPARAI'E PSI1MTTS
REQ('IREO T.'OII I:{.ECI, M€CII, PLB(I, C.AS
F.oI/II1, PRFFTIB$ & INSER
iS *
PAYMENTMETIIoo: flcnsH flcxecxlrnvrclEToNHc] frorlleccourur ffimcn4sr fJorscoveR
rf UPFIT * The
Shell Permit s:
.*I** I5 T}IIS A CHANEE
IF Yesr r,,hEt was
the prevlous Occupancy Typei
ARCII
DE5I6N FfiOFESSIONAL :
Is E1ect power on
this Building fi ves fJ ro
oF occupAlrcy use I f,ves IEI r,lo "*n**$hat
is the u€l\, occupancy Type?
EXST L.AND
DtsruRBtNo pERn4tr? [::lyes
fl ruo
SO FT
ACRE9 DISIURBED:
.."-
NEW IMPEFVIOUS AREA:
fr Ma€aBtW*ft hffi Brff *ffi ffi fr &{h
{odnr)
zorvr,fl6$*oFFrcER;REVISEO OAT€ 4JlV12
Approval:---.__
PEfiMITFEE:$"-