JANUARY 13 2016 BUILDING APPS-.$
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#tvo pt,Anls I ot b-lb]'-,?4A-NE[^I HANOVER COUNTY BUILDING PERMIT
APPLIQATIOT rYPE: RESIDENTIAL
PLEASE AUSWER AU- QUESTIONS APPLICAE|-E T0 YOUR PROIECT
"Project Responsibility''
5D5 DATE :
APPLICATIO{
I{umber
(offt.e Use)/4?kAPPLICATIT'S t,IAfiE :
DEVELOPER:PTION E *:
PRO]ECT ADDRESS:crw:
LOT T:
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PHONE
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ST:-ZIP: Wr
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SUBDIVISION:
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BLOCK #:
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ExrsrrN6 coNsTRUCrrOil :ffaLTERATTON
f| nrlovrrroru
[ crrrnal neearns
! RELocarroN
r{E}l coNsrRucrrorr
! enecr NEU RESTDENcE or
I morrroH To ExrsrrNc REsrDEr{cE
COI'ITRACTOR:
AI'T'RESS:
LICENSE T:
CITY:
Ei,IAIL ADDRESS:
<:o/v'l
PRO]ECT CO{TACT PERSON:
E CHECK AND AiISWER BELOt4l ALL THAT APPLY TO YoUR PROIECT:
SF
! en reuxous e
-
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PROPERTY OU'{ER'S tIA}'!E :
OT'.l ER,S ADDRESS:
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PROPERTY USE
/ OCCUPANCY:
DESCRIPTION OF WORK:
ATT GARAGE
SUNROOH
.,th\?fl sr ! oer canece sr
! eoncH
-
sF
I noor
_ sF
I orcr
_ sr
! sronaer SHED
_ sF
OTHER :
TOTAL HEATED SQ FT:
_ TOTAL SQ FT UNDER ROOF:
_ TOTAL AREA SQ FT: _
ToTAL PRolEcT CoST(ressr,oo,
S
fi fu * f oF SToRrES:
Is Any ELECTRICAL, PLUMBIT{G or MECHAT{fCAL Work
Beiog Done to the Accessory Structure?
[ V"r [ ruo
If the project is a Relocation,
is thene a Natlral Gas Line on the current slte? [ ves [ruo
Is there Electrical Power
on tnis auitdine?.XSves Ito
NGLE FAI,,IILY DUP LEX
! rownrousr
ts-,a( 3 A'rn,
rAl-
I
DISC|AIMER: lhsreby cerlily hat all inlormation in bis applicaton is
correcl and allworkwill comply wih he Stat€ Building Code and all oher
aod ordinances and regulatrons. The NHC Oevolopment Services Center willbe notlied olany changes in he approved'ge in
contracoror
conracbr intoma[on. "'NOTE: Any Workropriat€ Pemilswillbe in Violation of the NC Stats Up To $500 00"'
Ol,lNER/CONTRACTOR :rfa-SIGNATURE:
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* ** ** * * * * *** *(i!'Il lil"] * * * * * * * ** * *** *,
rs rHE pRopERw LocArED rN i ,.-oo,-or*
E ;.t Ef-;
NERVIOUS AREA:
-
SQ FT
nWATER:PUA
CoI'1!IUNIW SYSTEI1PRIVATE h]ELL
I cnrrnal wrll
SEWER:PUACENTRAL SEPTICPRIVATE SEPTIC COI4MUN ITY SYSTEI..I
EXISTING II4PERVIOUS AREA:
_ SQ FTTOTAL ACRES DISTURBED:
EXIST LAND DISTURBING prnmrr:
ll'l yes
lI uo
d;
**+ STPARATE PERIi,IITS REQIJIREO FOR ELECT, fiIECH, PLBG, 6A5 EQUIP, PREFABS4 INSERTS **+
payitENT
itETHoD:
I cAsn
I cnrcK (payABLE
ro rinc
1
[ +rrucaN ExpREss
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ZoNE : 0F FICER :
(roR
offlcE ust
or{LY) REVISED OATE
04111/12
SETBACKS: F:_ LH:_ RH:_ B:_
N
AppnovaL:- City:_ DATE:_ FLOOD: _BFE+2f
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