FEBRUARY 11 2016 BUILDING APPSffi
NEhI HANOVER COUNTY BUILDING PERMIT
APPLICATION IYPE I RESIDENTIAL
PTEASE AI,ISI.IER ALT QUESTIONS APPLICABLE TO YOUR PRO]ECT
"Project Responsibility"
N\=.,, (oc\:-
CITY:
CITY:
No$e
PHoIE *: arcr t1q. 1Oa \
pHONE f: or 1o - <611--lOt \
sT: FtC zre : ZBq t1
,t,[rro,2St t \
PHoNE *: c\\O [\a-10t\
SF
SF
\ ooo---J--
lott, .-to3
APPLICATION
Number
(office Use)
DArE: .f- \\ \G
PRO]ECT ADDRESS:
SUBDIVISION:
PROPERTY OITINER'5 NAlilE :
OIJNERTS ADDRESS:
CONTRACTOR:
ADDRESS;
EI!4AIL ADDRESS:
DET GARAGE
-
SF
POOL _ SF
DECK SF
\\ ".. i ^r, \nc..
STORAGE SHED
LICENSE *:
CITY: l.'t PHoNE *: cri.o-Aqq- _]o<(\
PRO]ECT CONTACT PERSON:
ALTE T ION ffi nrnovnrron !GENERAL REPAIRS RE LOCATION
NEI,I CONSTRUCTION:ERECT NEW RESIDENCE or ADDITION TO EXISTING RESIDENCE
**PLEASE CHECK ANO ANSWER BELOW ALL THAT APPLY TO YOUR PRO]ECT:
! concrr
-sF
OTHE R :
rorAl HEATED sQ Fr: zzoo rorAL sQ Fr UNDER noor 'z-j!9-
TOTAL PROIECT COST tress ror) : $(e COO.oo * OF STORIES: 1
PROPERTY USE / OCCUPANCY, ffi SrruCle ral,1rrv ! ouerrx ! rowrttous
€X
O[llN ER/coNrRAcroR: V\)erir K-oO\a=
o aton ofthe NC Sla
SI6NATURE :
TOTAL AREA 5Q FT:
Z
Is Any ELECTRICAL, PLUIiIBING or I4ECHANICAL work Being Done to the Accessony Structure? flV", I no
If the project is a Relocation, is there a Natural Gas Line on the current site? [ ves I lo
Is thene Electnical Power on this Building? ffiv"t [ruo
DESCRIPTION OF I,IORK
ER: lhereby cerli, tr at ll inlbrmation in tris appli€aton i\conect and allwork wilcomplywitr lhe Buildinq Code and alloher
and ordinances and requlations The NHC Oevelopmenl Services Cen ter will be notlied ofany changes in lhe apprcved plans and specifrcaiions or change in contracbr or
b Bldg Code and Subject to Fines To $s00.00"'"
,(u r
c<:Srale
inAo
:e\co
confacbf inbrmadon "'NoTE:Any Work Performed W/O he AppropriaE Permits willbe in v
IS THE PROPERTY LOCATED IN A FLOODPLAIN? N YES EI 'O
EXISTING II4PERVIOUS AREA:
-SQ
Fr TOTAL ACRES DISTURBED:
NEW II4PERVIOUS AREA:
-SQ
FT EXIST LAND DISTURBING PERMIT:
WATER: lX. crnun ! coMMUNrrY svsretl ! PRTVATE WELL CENTRAL WELL
srwrn: f] cFpuA E CENTRAL sEPrrc $ narvarr sEPrrc E coFlMUNrrY sYsrEM
*** SEPAIIATE PERIIITS REQUIRED FOR €LECT, I\ECH, PLBG, GAs EqJIP, PREFABS & lNSERTS ***
pay.4ENT r4ErHoD: E cosn E c*recx (,A'ABLE ro ,,c; I amrnrcA, ExPREss E uc/rrsl I orscoven
*)tr(+ +** *)3)t)t +)*)*)* **)t)t )t+t * *,k )t +*)* )* )*** )tr(tr(* +i*)** *r(*tr( **r*** )* )* **** +** )k )k r( x(* )t++++i** *** )t i( * *,*,* * r* **x)k**
ZONE: _ 0FFICER:
(FOR OFFICE USE ONLY) REVISED DAIE O4l11l12
SETBACKS: F:_ LH:- RH:- B:-
YES I--l Ho
Approval:-City:- DATE:- FLOOD:
-
BFE+2ft=
-
AVN
Comment:PERMIT FEE: $-
r ,'' , \ r-..., , c.-..\<- r-
BLOCK s: ) LOI *l
ZIP: ais L\ \\
APPLICANTJS IIAA1E :
DEVELOPER:
! lrr cannce
-
sF
! surnoom
-
sF
! cnerrurousr
-
sF
ExIsTII{G CONSTRUCTIoN: fl
\
''j'.
&
APPLTCA T,S NA'4E :
DEVELOPER:
NEW HANOVER COUNTY BUILDING PERMIT
APPLICATION IYPE: RESIDENTIAL
PLEAST ANSIIEF ALL QUESIIOITS APPLI(ABLE TO YOUR PRO]E(I
.\, . "Project Responslbi]lty"/,\ \ ,,',r(,,VLrLl;\ rc..,\
APPLICATION
Number
(offi.e use)
D,;Et I -)-tL
PIO E #:
PRO]ECT ADORESS:
SUBDIVISIO:ELOCK *:
CITY: q-)
tt .<j-a r i')
ICENSE ':cIrY: i .r,lL: 17you,1,
LOT f:
PHOTIE #:
srt uL zr1t 29f ii
--7--- prioltr o '
(/f)
..,P, y't1*i
:\zrp,lS!tr
NA'I,IT:f .;r }}a-ffo1PROPE RTY O!I?'IER'S
O.II{ERJ 5 ADDRESS:
CONTRACTOR :
ADOR€55:
f r)5
5T:
I surnoo,r
-
sF
fl cn:rrxous e
-
sF
ENAIL ADDRESS:
PROPERTY USE / OCCUP
DESCRIPTIOiI OF WOR|( :
. coi
( ai{A.{-/*ane *,(full3f:L1JJ
/-,5
PRO]ECT CONTACT PERSOTI:
EXISTIiJG CoiISTRUCTION: I alrenarron (.r**orro* [ crrrnal necuts f]
TIEW CONSTRUCTION;ERECT NEI{ RESIDENCE or AODITIOI,I TO EXIS]ING RESIDEI{CE
'.PLEASE CHECX Al'lD At{Sl/ER BELOT'J ALL THAT APPLY T0 YOUR PROJECT
ATT GARAGE
-
SF D€T GARAGE _ SF I eoncH _ sF
RE LOCAI ION
STORAGE SHEDPOOL SF
DECK SF OTHE R:
5F
SF
TOTAL PROI ECT COST rress r-ori : S {-- ,. s OF STORIES :
Is Any ELECrRICAL, PLU,,l8Itl6 or iIECHA ICAL l.,Jork Belng Oone to the Accessory Structure? EI V"t fl lo
If the proje.t is a Relocation, is there a Natural Gas Line on the Curnent Site? [ ves [ ruo
Is there Electrical Powen on this Building) Flves l-'1 rio
ANCY :SINGLE FAHI LY DUPLEX IOI^/NHOUSE
/a
Codc a.d Sub,ed tl Fin.j Up To i500 ocr'
a
DISCTATMER lh6rsby.ertit hataltinbmalion in his applration is conocl s.d aI wo.k wrlr.of,pry wifl he Slals &,ldng Code and slloh€. apprrcabb Snlb and r.c6tlsws
and ordina.c€s and .€gularions Ths NHC O€ !€lopmenl S€rulc€s CenE. wil bs nolfied of any changos n h6 6PP.ovad Phni and sp€cifcalions or ch6ng3 i. conrraclcr o,
ot{NER/C0
alol "'NOTE A.ywork q.donEd w/O t'eApP.opaa€ p.m'tiw 'be,iVoLlono'lheNCS
TRACTOR: ,l ,:Lr", i Loh44 SIG ATuRE:
rr****r+****+*,i,,,r**.r'r****(liTlNiTJ.**,*****.**+++,r+**+,r*,ri**+i,r,rr**i*r**r1**irrsr,|*****
rs THE PROPERTY LOCATED rN a FLOODPLaTi{} El YEs E no
EXISTI G INPERVIOUS AREA:
-SQ
FT TOTAT ACRES DISTUREED:
NEW ITIPERVIOUS AREA:
-
sQ Fr EXIST LAND oISTURBING etnmrr: f] ves [-l uo
WATER :X) CF PUA ! counulrrv svsreu PRTvATE wELL ! ctrrnar well
SEI.'ER: E CFPUA E CENTRAL SEPTIC PRTVATE SEPTTC ! COrmUrtrV SvSrrr,r
**I SEPARATT PER},IITs REQUIRED FOR ELECT, I.IECH, PL8G, GAS EqUIP, PREFABS & It6ENTS '1*
payltGMl HETTOO: Icasn f] c,recx (PAYAsLE tO Url I anrnrcaN ErPREss E rclrrsl ! orscovtn
**tr+*******r**a*rtt,r,I*r,*t***,t****)i.**,i****t****)t,t***t***t*ir***a**rt*r******r***********
ZONE: 0F FICER:
(roR oIFICE rJSt Ci{LY) REvlsED DArr o4ll1r2i
SETBACXS: F:- LH:- RH:- B:- -l t
Approval:- cityr- DATE:- FLooD:
-
8FE+2ft=
-
AVN
crw:
r
TOTAL HEATED SQ FT: +.,,'. t- TOTAL 5Q FT UNDER ROOF: . TOTAL AREA SQ i-T: .. -
15-3568
,a'ri''iii \
(ffi-.,
NEW HANOVER COUNTY BUILDING PERMIT
aPPLIcAtIo,]t rYPE; COl4I,lE RC IAL
PLEAsE AlJSilEi Ar-r QUES'rIoN5 APP'JCAALE TO youi pqol€Cr
"PeoJect Responslbtltty"
4a
APPLTCATIOII
Numbel.
(offi.. Us.)
APPLICANT'S N'$IE:z-oarEt 12'2t l'
ztPt2g 4CB
DEVELOPER:
PRO]ECT ADD
PHONE #:
PHONE $:
PHONE
RE55: ;*-,- lter-aalt e.-,
OCCUPANT/BUSIIIESS NAI1E :
PROPERTY OWNER'S IIA'.IE I
OWNER'5 ADORESS;
CITY:
CITY:J
%.LICENSE #:
CITY;
CONTRACTOR:
ADDRESS:
Ei{AIL AODRESS:
PRO]ECT COI{TACT ERSON:
O'rrl
_ 7. (c!..r lll
L{ REflo/ATrofl'Cune Slte? Ll
st;AEztPt'722)L
sr:a'zrPt 216(J z
e,i5s.t-4L-zb3{
I
)
I
EXrST COTSTRUCTTOruI fl llre UrrO't
l, Relocaton, is here a Natural Gas Lino on th6 Yes Er'u
NEW CONSTRUCTIq.I:ERECT NEW STRUCTURE I rrsr rucx f] sn
tr GEiIERAL REPAIRS RELOCATION
xleneor Fl v.. ll Ho
PH0NE *:Walk!LO1+
AOD TO EXISI STRUCTURE
IS ELDG SPRIN
*:fu'q,?*
/$
r+>N
: \\
L ..
?6
rh
f4t_\
If UPFIT - The Shell Pernit *:rs Elect Polren on this Building Vl yes f] Ho
ARCTT DESIGN PROFESSIOT,UL:?u'4E.q7z-/_-"-*.P{ f lQ.g--7. (42)
XC REG S: l ariS 4 I
Nc REG s, h22 64
DESCRIPTIoN 0F
'IORK
i
16 food or bovefages p.Bpared or ssrved in ttrls o*"rr"zflv""No ls Th€ Prcperty Locabd tn rt e frooOganr I Ves ffruo
0ISCLAIMEF: IFerlly csrlt ulat alllnlbrmathn ln
.rd locd llE.nd ord'nanEs and tE{oladorr!. Tha
or chano6ln contmc'"cr o. conracbr iitdmruon. -'
Subje.llo Finer Up To S5C0 00'-
trb aoplba{on b corct rld dr v/ort l,lJlll cohEt wth hc Slat Sottdt.o Cod€ .nd
NHC Deveboli.ni Se.vic6r Cenl6.wi !De roUliad El siv Ehandes,n th; eDmv.dNOIE: Any Work P.rlblmBd \Y/O theAgrrcDdar€ PEnnfu q,i t:is inVlo oti6i o, th;
ell other aopllcabl. Slata
,la,x andsr€cdlc2rbns
NC Srots Eldg Cod€ 6nd
- OWNEFYCONTRACTOR: -i\A..It-.<J.J.-I,U{-/ SIGNATUR&f,.r*f wu' - (Ahr{.d)
-#idre: d.molldon nof!.ltoN a rb.3o. Ig'loval p.nnll sppllc.too, a.! lo b. rlllrh.d u.lng it. agplkadon tol'r
EIiGR DESIGN PROFESSIOI{AL
TOTAL SQ FT UNDER ROOF: "#OFSTRUCTURES: 1
E:
(0HBS:.3768) sttcrtr( 013 hdfiy d hrlld e w.s t iJnd lo
.ontEin Arbo3loc or nol Ydr Er6 r.(trJrd lo c8ll lrrit Nirtonrl Bnhdor Stdrd!fr. td Hradolt Ar Polu.rlt' (NEStUP) !t (9'tg)707-5950 .t t!!d I O d6y! !|ior lo $ro
demol'!6 ol !ry hci.lry or bQddlng. S.o A$.sb. W.b Slb: tap/r\.tr..pl.rtsb.neuslof.t/elto3ros/Bh6p.hrnl
TOTAL PROJECT COST E-AfuL BUILOING HEIGHT:
SO FT PER FLR:
f OF UNITS: ]
TOTAL AREA SO FT :, t2-z # OF STORIES:
, OF FLOORS:
ACRES DISTURBED
NEW IMPERVIOUS AREA:SO FT
WATER: ECFPUA
SEWER; fl CFPUA
-. SEPIM'E P€q[1I--S AEOUIREO FOR ELECI. M€GI, PLBG,6A5 ECUiP. PREFABS & INSEFTS ''
pAy ENT METHOD: ICaSX ICXeCK (PAYABLE rO NHC) flaUenrcar exeRess Iucnasr E orscoven
i,
(FOR OFFTCE USE ONLY)ZONE: OFFICER:SETBACKS: F:_LHr_ RH:-- B:
ErsT LAND DrsTURsrHc nenlrnr flvesPlNo
E(SING IMPEFVIOUS AREA:
flcoMMuNmy sysTEM D WELL f]ZONTNG USE CLASSIFICATION:
f-ICENTRAL sEPTrc LJ PRrvArE sEpIC f:]coMMUNny sysrEM
SQ FT
REVISED oArE,.lt1lre
AoDroval: Citv: DATE: FLOOD: RFF+*r=
.o,,"n, ;r;;r.;--J ?1! ,d'
lr":''r,-..
ACCESSORY STRUCIUR€:
....r rs lrrs A cHs,lGE oF ocorpaflcy use; ffivrs f] 116 .....
IF Yes, rdat m5 the Prevleus Occupancy Type? _ tihat ii th! lte* Occup.ocy lyp€? _
pRopERTy usE: EoFFICE lnesmumNr fir,,rencer.mLe fleOuc I arr lCoNoO oruen:
) crb -Far
hrt 15-3568NE[^I HANOVER COUNTY BUILDING PERMIT
APPLICATI0N rYPEi COMmERCIAL
PLEASE ANSb}ER ALL QUESTIONS APPLICABLE TO YOUR PRO]ECT
"Project Responsibillty"
4a
IS BLDG SPBIN
'<^Dlz'SHELLFI\PFTT
Kl ERED? L/l Yes I lNo
APPLICATION
Number
(offi.e Use)
APPLICANT, S NAI'IE :
DFVELOPER:
PRO]ECT ADORESS:CITY:
OCCUPANT/BUSIIIESS NAfiE :+
PROPERTY OI,{NER, 5 NAI'IE :
Otr,lNER'S ADDRESS:CITY:
CONTRACTOR:rf+z-<-t LICENSE #:
CITY:AODRESS:
oAtE: 12'zt' 11
ztP:26 zliB
PHONE #:
PHONE S:
sr;$pzw::zz7Lr
ST: ZlPl
PRO]ECT CONTACT PERSON:
(check all rhat
^pply)
lf Relocation, is lhere a Natural Gas Line on the
f] rurrmrrou /^
Curre nt Site?
ENOVATlONtr u GENERAL REPAIRS RELOCATIONEXIST CONSTRUCTION:tr
PHONE S:
PHONE #:
I
)
I
,l
I $
Yes No
NEI,I CONSTRUCTION:fl enrcr NEr,l srRUcruRE FAs' TRAC(I loo ro Exrsr srRucruRE
ACCESSORY STRUCTTJRE:
If UpFIT - The she1l Permit *: rs Elect Poten on thls Euilding AYes E ftfo
.r... rs r1rs a cHAllGE oF ocorpAlcy user flvas I io .r.,.t
IF Yes, Hhat las the Previous Occupancy Typ€?l.ihat i5 the NeH occupancy Typ€?
ARCH DESIGII PNOFESSIONAL;l$ q6'qfl,t -*. Nc REG *:
PHt 3.&frz:la C REG #:
DESCRIPTION OF WOR(:
i{
!
N
\
_1
(
)
,l
LI ls rood or beverdgss prapared d served in lhis sfucll,6?EYes No ts Th6 hoperty Located ln The Flooddain? f]v"" [[No
ENGR DESIGN PROFESSIONAL
OWNER/CONTRACTOR:-l-)A,,..
OISCLAIMER: I herEov cer{rv lhat all lnforrafon tn thrs appllcahon ls co.rect and ail wolk l^lll corply wrlh th€
and local laws and ord nances and rBoul6dons. The NHC Devsloprngnt S srv'ces C€nlerwll b€ nolilod of ary
ot chanoe ln conlraclor or conlractor |-nlolma on, h'NOTE: Any Work Performed w/O ['l€ Appropriale Pennlls
Subjecllo Fines Up To S500.00*
Sta!€ Eulldlng Cod6 and 3l ohe'appllcable State
chanoes ln the aDomved Dlans and soecificalions
will Dle n Vloration ot rh6NC Stats Bldg Code and
.,-\.ta,-SIGNATURE:Xe-rtr (qdii.d
-.:+!!!ie: demolldon fl oLtlcalions
TOTAL PROJECT C AsT: ,g;Lbfu
TOTAL AREA SA FT : _d+JZ-
& asbosloi removai podrh appllca0ons er6 to b6 submlfl6d uslng lh6 apFllca{oh tofln (DHHS-3768} wfiother fi6 hcilily or bllldlng was faund to
cor{ah Alb€rtoo or not You arB r6qul..d lo csll 0ro Nalor.l Emls3loo Slard6rdB for Heze ddJs AIr Pollutarls (NESHAP, at (91gr07-5*i0 at l.ast 10 dayr rlrior to fi6
demolidon r,' ary ftcillty or bulldtng. S€. Arb€sE W€e S[b: ht&;/ww.6pl.stato.rc.us/epuas!6lo!/ohmp'hlrnl
EUILDING HEIGHT:
SQ FT PER FLR:
# OF IJNITS: I
TOTAL SQ FT UNDER ROOF: h # OF STRUCTURES:# OF FLOORS:
D<sr LAND Drsrunatrue eenr,tna fl ,c>flNo
TT coMMUNnY SYSTEM T-IWELL IZONING USE CLASSIFIC,ATION:
--fi carRru-seerc flpRvArEsEPrlc flcoMMUNIrvsYSTEM
ACRES DISTURBED:
NEW IMPERVIOUS AREA:SQ FT EXISTING IMPERVIOUS AREA:SQ FT
pRopERryusE: f]oFFrcE [nesraumNr fiIvreno+mLe lEouc [nrr [cor.roo OTHER:
WATER: ECFPUA
SEWER: T"ICFPUA
. SEPARATE PERMITS NEOUIRED FOR EIECT, ME6I, PLSG, GAS EOUIP, PREFABS & INSEFTS'
pAyMENT METHOD: [cnSH ficneCr pnveelE To NHC) fleuentceN eXeness I ucnnse flotscovrn
' (FOR OFFICE USE ONLY) REvlsED DATE 4r1ll',12
ZONE:-OFFICER:SETBACKS: F:-LH
Apprcvd:-_ Ciq[- DATE: FLOOD:
---
BFE+2f,=-
AVN
: RH: B:
3->t
Comment
C-rtq Frr€-, hr#trcc)
PERMIT FEE: $
lvtb2-og
\I 11
Ei,IAIL ADDRESS:
loo 4l
/\?2 64 +
#OFSTORIES: /
s
U
APPLICAI{T' 5 MIIE :
DEVEIOPER:
PRO]€CT ADDfiE
SUADIVISIOI:
Jolb-lr?Y
NEhI HAITIOVER COUNTY BUILDING pERilIT
APPLICATI(N Tvpe: RESIDEI{TIAL
prEAs€ AIS|iER ALr gJtsTloais AppIICAaIE TO ydJR pROltCT
"project Responsibillqf
.J,
15-3533
d,t,
iffir-i{'.
APPLICATIOT
u|tber
(Offl(. Use)
I k,DATE :
PHOr.rE a:
/)
ZIP i
LOT *: /
CI TY:
t1 jtn
CTTY:
)1 LICE SE
a
Plr&tE #:
BLOC( #
PR@ERTY OI{ER's
oto{ER's ADoflEss:
ADDR E 55 :
EITAIL ADDRESS:
?,l
U s
sr Ai.-zii@ff)
t ,LL :airr)|'4{O
Pl€t{E $: .'-,')"Y-/sb/
CITY:
7t
PRO]ECT CO TACT PERSO{:ts<-P}ONE S:2bi
Exrsrrrc co{sTRrrcTrox: f] alrrnarrox ! n $rwarrot f} e ene nar- neruns f} RElocrrro
[Er{ cor{sTRrrcTlolt' Q',ene cr xE], REsIoEr{cE o" fl aoorrrol TO EXISTI RESIDENCE
CHECI( AIi,D At{Sl{ER BELoI{ ALL THAT Apply TO YotJR pIOJECT:
ATT GARAGE
,-1 -)-1
. / , I sF lJ DEr GARAGE _ SF RCH 3 SF
fl sunnoor _sF f] roo.
-
sr
SF
f| srome r sneo
OTHE R :
SF
I cneerxousr _ sF f] orcr SF
TOTAL HEATED Sq FT:TOTAL SQ FT tnDER *A"I,J'4,)TOTAL ABEA SQ FT:/4'l)
TOTAL PRO]ECT COSTtLessr.q . $ (,C)OO s oF SToRIES:
./-
Is Any ELICTRICAL, PLttEIl|G or tlECHlifCAL l{ork Being Done to the Ac(essory Structure? n yes
If the project is a Relocation, is there a Natural Gas Line on the Current Site? fl
on thj.s Buitdingl lJves f-l uo
c- <'1
No
YeS Dro
Is thene Electrical Por.ler
PROPERTV USE / OCC{JPANCY I
DESCRTPTIO{ OF }'ORK:
n SINGLE FAMIT Y I ounr-rx U5E
DECTInER Ihereb, c?itt natBI rli(Inalbn il nis applcaioo rs co.rr.clsxt al ryori ull eo$ply w,n h€ Srrt! BJiShe Code rld doh€r appltabS $rt rld bcd lftis
td onlnrrc.3 ..{ ,Egutatirrs- Tha NHC Oeyebpficnl Se i!3 C.ha. wil b. not*ld ol 'y cil.tges n |tle mrowd ol,)B 'ld lp€cfrtlbns or chaoge h conlrrbr or
contacbr iotmaton'-llOTE:
o{t{ERlco TRACTOR
IS THE PROPERTY LOCATED ItI A F LOq)PLAIIi ?
EXISTII,IG IIOERVIOUS AREA: _ 5Q FT
NEl,,l 1MP ci'rs AREA: _SQ FT
ArwWo.k P.tlodtEd lYrO lr.,-Do.. l-"l
APD.!o.t!i F.nhiE ,l
o'dis.yl SIG ATURE :
bc il vbbton or rh. NC sllD gdo cod€ md t) Fhes lJp To S5O0.OO"'
ito
TOTAL ACRES DISTURBED:
EXTST LAID DISTURBING PERI,IIT:l--] Yes l--l no
fl cerrnar url l
f] conn-nrw svsrer
BFE+2ft=
tP.int iL..)***tr+*aaa:l*tl*i***{t*+*aa*aa+a*talaa*+a**ta**t**4+t * * t * **t r ***,| *,1**,1* * *,1* ,t *)a** * **,1*a
HATER :
SEUER:
c
CF PUA
zor{E :
E YES
f] com,runrrv svsrem I pRrvATE uELL
fl cenrml secrrc I PRrvArE sEPrrc
OF FICE R:
.'* srp&,tar; ?a&BrYs *EqJtRE$ FoR rt.e(r, xE{,{, pla&, 6a5 EQL,:p, pnri,Aas & ittEgTg ,'+
pAvrErr rErioo: n clsr n creo( (payaBr-E ro nr1 [ lrr*rclr exeness E rrrrso n orscorrn
ar* ta, r r r,it I r a+ ra,ra r** **)i,r,i**a t* r a*it * i ir,ir,i't 't,i,r++ri*a* at*,F*:tt t *ri*rtr *,] at !F+r aia* ++tta++*:at
(roR oFfICE UsI qrtY) R€ylsto oaTE o4l11l12
SETBACKS: F: LH: RH: 8:
Approva}:_ City:_ DATE:_ FLoOD: _
Cdrent:PER}IIT F€E: S
1
4
J o /hlttJ
15-3s33NEtl HANOVER CqTNTY BUILDING pERttIT
APPLIcATIoN rypf t RESIDENTIAL
PLTAS€ ANSIEi ALL QUTSIIO&' APPLICASIE TO YG]R PRO]rCI
"Pro ject Respons lbili.t!'"
APPL I CATI O'{
llur6€ r
.t I
I tk'.APPLICANT'S MI{E:
DEVELOPER:
DAIE:.,, .
PHONF T:
PRO]ECT ADORES
SUBOIVISIOI: I
5 Jfr ClTY:
CITY:
SLOCX I i-;
ZlPt.-- .'.,
LCT #:
PROPERW OINER,S xAA[:
OI{NER'5 AmRE5S: l-l ,/
-t,p EH
5
cos,tTRAcT08.:
PROJECT CONTACI PERSON:
DET GARA6E SF
(L'LICET{SE ':CITY:
!I OTHER:
# OF STORIES:
Yes
il
/ \l)
sr:/.( zrp: ,i. '
PHONE $:
PtlOt'lE s:
EXISTING CONSTRUCTION :I nercvarroN I erNeRal Reerrns I RELocArroN
NE!,' CONSTRUCTION:ERECT NEW RESIDE|KE or I morrror ro Exrsrrrs REsrDEr,rcE
'.pLE4il CHEcx Aro aNsr{ER BELoti aLL THAr apply To youR pRotEcT:
ATT GARA6[5r rOFCH i"'i to
5UNR0OI4 _SF
GRETNHCI.'SE ST
PooL _ 5F
DECK
llr l I rorAr se Fr urip
,B,rd) ; t I ^,t,'ti
Is there ELectnical Power on this Euildlng?
pRopERw usE / occuPAl.tcY: I srNcLt r*trlv
ER RooF: /rlr/:l rorAl AREA se Fr:L,::1--.'
sToRA6: SHED _ SF
15 Any ELECTRICAL, 9LUISII{6 or MECHAITCAL i{ork Eerng Done to thc AcLessory stru.tr.e} E Yes
If the p.oje.t is a Relocation, is there a Natural 6as Line on thc Curnent Site? D
TOTAL HEATED SQ FT:
TOTAL PRO]ECT COST
DESCR IPIIOI{ 0F I,JORK
5;
No
OI,INER/C0IITRACTOR: ) ' ,
../,:- n, r, :. -a-.,, -.,,...r,1--.t)rtL-...1..-.
SIGTiATURE:
rrri 1,r r!rr *ra* a
YEs lLl r,ro
.'...,. -..rI:T:ii'il"-
IS THE PROPERTY LOCATED If{ A FLOOOPLAIX?
EXISTIiG I}IPERVIA,S AREA:
-9Q
FT
l{€l{ I}TPETVIOIJS AREA: _5Q FT 'OTAL
ACRES DISTURBED:
EXIST LAiD OISTURBING PERXIT:YES NO
I.IATER:
SEWER:I I CFNTRAI- SEPTTC L l
! cort,rur.irw svsre m fl nnrvarr llerl f]
:. _ -: ...i:.
CENiRAL l.,E L L
CO'II{JNITY SYSI[T,!
PAYI4ENT FThOD:clrtcr (PAYA8L E T0 HliC)D
)vl
v
,rxL! )
, "l.r
zoNE: fnl'L oFfrcER:
Approval.:_ Ci.ty
SETBACKs: F:,-jL +
oate :\Z'ZZ'l5rrooo:Brti:ft
Comment:
LH :.;i:
PERttIT
'
EE:
'
EITAIL ADDREsS:
*Q"
lz-
NEt^l HA}MVER COUNTY BUILDING PERT'IIT
aPPLIcATIott rrPf ; RESIDENTIAL
PttasF lxst{lH at-[ q]ts-rIois agp! Iaralt Io'/ctrR paoltaT
"ProJect Responsibtltt)/"
do/Gllvr
L5 -3534
APPLI CATION
Numbea
(offi(€ Ur€)
APPLICANT'S M}tE :
DEVELOPFR:
PRO]€CT AODRESS:
SUB0IVISION: Il )
I 4r I
L
CI IY:
CII Y:
BTOCX B:-
t,,
Plro,iE l: :
",
LOr *
PloilE #:t/
DATE: ,
sl:
PR@ERTY d*tER'S'.IA}IE :
OllNER'S AOORESS:)
COTIIRACTOR:
ADDRESS:
PRO]ECT COi{TACT PENsO{:
LTCENSE T:
Sf
ST
Pt{,tE *: / l.
PHr-'trL- f:
SF
SF
rt:f'1t
tiJ
CITYr
)/:j;/
EXISTING cO{SrRUcTIor: I aLTERATION I ner,OVarro I errurnll nrerrns f] RELOCATTO.i
rEr co.isTRrrcltora , D'{*rfi N€r{ REsroEr{cE o" f] amtrrol To ExrsTIr6 RtsroENcE
L€A'€
SF
f] sumoon _ sF
I enrrmra,rse
-
sF
OESCRIPTIOTT OF WONK:
CTIECX AXD ANS|.IER BEL6{ ALL TTI4T APPLY TO YOJR PRO]ECI
))
PooL _ sF
DEC( SF
TOTAL HEATED Sq fi. I/., .;. i TOTAL 5Q FT UNDER ROOF:.I t
TOTAL PROIECT COST rellou , t (-:"i/-l-( '' * OF STORIES: t'
t5 Any EIECTRICAI, pLU,naUaG or IIECHAxICAL lbrk 8€r.ng oone tc the ac(eetory Stru.turei
TOTAT AREA SQ
q.!
If the project is a Relocation, ii there a Natu.al Gas Line on the Cu..ont sitei Dvc:
Is there Electrical Power on thts Buildingl flves fllo
PROPERfi USE / OCCUPfiXCY: E .' :.i F F:it1t f I cucrrx
.o^r&r,.rbh..on'-NOTE,ltY
otfJgR/€oi{TRA(TOR:
m'lsv b. nvDt uon otlh. Nc sEr
\ I SIGNATURE:
rPr!6! lli*
TOTAL ACiES OISTURBED:
EXIST I AND DISTURBING PERI{IT
11{/ v I sA
rs rHE pRopERry LocArED rN A tlooplAr t f] yEs
EXISTI'IG I'iPERVIOUS AREA:
-SQ
FT
NEl, lliPtJavIOJS AREA:
-SQ
FT
El-rc
I.IATER:
SFI.]ER:
[fr co( [ cor,uurrry sysrEH f] cnrvarr well
I cerrnar. srnrrc f] PRrvArE sEPTrc
C€NTRAL I,,ITLL
CO'II{J}I I TY SYSTEH
NC
payxExr rETHooi f] c^s, Dcreo, (PAYABLE To rl{(; fl^}re rran excntss
:,ETBACKs: Fzor'rp: fhF L oFrrce q i'..* t*, y RH: + B: *
\ BFE'?ft=App.oval:_- ci ty:- DATE;
Coi:nert:
iZ-Ll'l 5erooo
.1 PERIIIT FEE: t
€IIAIL ADDRESS:
rrr Ft.'r']<
lz
"r.r,rfil:4n
APPLICAIT'S tt^'IE :
OEVELOPER:
PROJECT AO}R
ST,BDIVISIO{:
& olto- ll'ls
15-3s34NEhI HANOVER COI'NTY BUILDING PERiIIT
APPLICATIq| ryp€; RESIDEHTIAL
PTEASE ArlSI'€R ATL QJESTTO'IS APPT ICAELE TO YCUR PRO]ECT
"ProJect Responsibiltty,,
),9yt
crw:
ELOCX S
-k4
CTTY;
LICE}lSE S:1
CITY:?t
5IORA6€ SHED
APPLICATI(I{
Itrmb€r
(Offlc. UJe)
DATE | li 2 '/tqptlo{E r:
tOt *: /.?-=_
PHO E t:7?t/-
ST: dl zlp:
PROPERTY (X{ER' 5
OrtlER'S AooftESS:
ADDR E SS :
EI&IL ADOR€SS:
SUNROO|I _5F
,/
k
tl,
-)
Z.r/
1
u -t
st:19|ue
PIO{E T:
P}b E A:
?
PRO]ECT CO TACT PERsO$I:
Exrsrrlc C0$Tnucrror{: ! llrsnarrol I nercvarrox f] ernenau nrnuns I nrlocrrror,i//
NEI{ co smucrto r ffinrcr EH RESIDE}rE or Tl ADOITIOT{ TO EXISTIi}G FE5IDCTICE
CHECX AiO AIISXER SELOT' AL
TT C,Aerce ,,') )SF
L THAT T'PLY TO YCt"h PRO]ECY:
I orr caucr sr Q6,cx
g I
JA 5F
P@L SF 5F
SFf] eneruouse
-
sF I oecr _ sr orHER:
TOTAL HEATED 5Q TOTAL SQ
TOTAL PROIf,CT CoSl,iessrou : f * OF STORIES: /'
w, lt" i'|Fr lff\DER R@F. 1 I L/,)rorAl AREA * rr, fjSl ,*
A(cessory structure? f! ves I frfo
ne on the Cunnent si.te) ! V"t I Uo
Is Any ELE(TRICAL, PLI.FI8IITG o. lE€Hlr{ICAL Hork 8€1ng t}one to the
If the project is a Relocation, is there a Natural 6as Li
Is there ElectrlcaL Poser on this Bullding? l-l ves l-'l Ho
PROP€RTY L'SE / OCCI'PA"CY:
DESCRIPTIOT OF UORK:
tr SIIi}6LE FAI'II LY tr UJPLEX C[.JNHOUS E
OECLA|IER lhGtaoy c.ruy nd.t nrbfinslnn n ,rl5 +phdbn B c..r!cl md ws* wit compay trrn ,le Srrre &r,biu Cod€ r'd d onrr poradlg Sr.b &d tocd lnis
i.t6 6.6fir'..: ttd €o{,|.b{!3 The NllC Davcbpn'Ent Sarvat! Ccnlr ttl b. noff.d of rty ch6n0€3 h rhr app.owd pb.!3 'ld lpa<Jrarnon3 o. chrD. n csrExbr or
ctrrtebr nbmrb. '-llOTE A.y lryo P.''olvl d W,l) l|l Apg.Dpri.r P..mrE rtr b. n Vxrbbr or or nC Siltrl I(HIER/qXTRACTOR: l-.L c.,' h lc."Clt 5r\ r SIGMTURE:
{p.tnt iir.)taa!}aa*a*ataa..*tr*raariaaaa*aat*aiaaa*taa'a:t:t *aa a1. a.
rs rH€ pnopEiry LocATED r{ A rLG)pLArit l-l vrs
EXISTIiaG IIIPERVIOUS Af,EA: _SQ FT
I D Fr'.t lb To
'5OO.OO."
* + *,| * t *** * a * r;** ** r tr* * r r*t+*:|*,a *
t{o
TOTAL ACRES DISTURBED:
NEt,l IflP
c
AREA i 5Q ST €XrST t AI\E Df STURBI|,I6 PEnHfT:vrs l--'l rn
fl conarlrw svsrer f] pRrvArE I.,ELL f] celrnal wrll
f] cexrnal srrrrc f] pfirvArE sEprrc I conr.r.nrrv svsrrm
T.IATER:
SETER:CFPUA
*" srpArnrE PfRxtrS [cQJIRE0 Fce rtECT, i{EC,{, pr,8c, 6a5 tiQulp, ?*EFA85 & "r{5tirl .a'
payr.Exr iErlrxr: I cesn I creg (p y sLE rD rry f] rrc*roe exerrss E xfvrso I orsconr
* t rr r t a,a r r a *rr trt* a aa,r + tr ?ral a t a aai,l 'l a 1l * a:l+::,itr.a r a t*'latat:aat.*rtatt*i tt* t att l,rt+ttat*+
{roi oFrIcE us, oatY) i€vtJE oaT! o4lr1l12
SETMC(S: F:_ LH: RH:_ B:_ZONE:
-
OFFICER:
Appnoval :_ City:_ DATE:_ FL0OD: _ l_
Cment:
BFE+2ft=
T;*,,,1fu7_
T-,.
?q
,
U}X taoili,v'w*M?A-3
tvl Ittb-tt(/
NEW HANOVER COUNTY BUILDING
APPLICATION IYPEI COMHERCIAL
PERMTT W71bbq71
APPLICATION
Number
(Office use)
<5iA)c{-o oorr,rzlf4tt
,&,'
APPLICANT'S NAME:
PLEASE ANSI'ER ALL QUESIIOI{S APPLICAELE TO YOUR PRO]ECT
"Project Responsibility',
BlJ \^l r
DEVELOPER:
PROJECT ADDRESS;
occUPANT/BUsINEss NAIIIE: TgD
PROPERTY OI,JNER'S NAIiIE :
Oh,NER'S ADDREsS: ZSOI 7I ,,@1 D6 vn crrY:
CONTRACTOR:
CITY:
PHONE S:
ZIP i
I olher applicable State
S
qgaE)2v
sr.l1;,l.ztPt-ru{f
LICENSE #:
ADDRESS: Al t+NeoE,adB CITY:
EMAIL ADDRESS:
PRO]ECT CONTACT PERSON:
EXIST CONSTRUCTION:
lf Relocation, is there a Na
NEN CONSTRUCTTOru: ! eneCr rew srnucrune !FAST TRACK
ACCESSORY STRUCTURE:
If UPFIT - The shell Permit #:
IF Yes, |rhat was the Previous occupancy Type?
ALTERATT.N a *.rJiiii'# 'g!*I*
Gas Iine on rhe Current Site? [ves [ruo
srt&izrpt?B+A
pHoNE *qlOS?€ ZqF
PHONE #: lt tt
AL REPAIRS RE LOCATION
IS BLDG SPRINKLERED?Iv"" [No
SHELL UPFIT ADD TO EXIST STRUCTURE
What is the New 0ccupancy Type?
tural
Is Elect Powen on this Building n yes
***'* rs rurs a cHANGE oF occupANcy usrl Ivrs f]ro ---,-
ARCH DESIGN PROFESSIONAL:
ENGR OESIGN PROFESSIONAL:
Nc REG #: DD=A
NC REG #: lc'. Ra?c'%>ze|rA)ZUC
s. The
PH
LDESCRIPTION OF UJORK:
ls food or bevorages prepared or served in this structure?[v"" ffio b The Property Locared tn The
DI rhal all informalion in
in?ves I t.lo
lhis applicalion rs correcr and arlwork wllcompty wrrh lhe
NHC bevelopmenr Servrces Cenlerwi be nor;tr6d o,anvNOTE Any Work Perlormed w/O the App,opnale Pern),ls and
late
soecrllca ons
Bldg Code and
and
SU
demoliton of any lacilily
TOTAL PROJECT
TOTAL AREA SO FT :
TOTAL SQ FT UNDER
ACRES DISTURBEo: $18
NEW IMPERVIOUS AREA:
Stale
ion, "'
OWN
Nole: Dgmollton rlotlficalioos E asbestc re.noval pemit applicsuons are to be submhred usiog tho appticalon brm (
contain fubesios or nol
?,v,sAZfutarWa SIGNATUR
f;ffi*^rr;rga.;q
aoor:6ldo9_
ily or building was folnd to
Embsion standards for Hazardous Air Poltutants (NESHAP) al (919)707-5950 al teast lo days prior to lhe
hlipr/ dwwepl.state.nc.us/epl/asbeslos/ahmp.himt
BUILDING HEIGHT t1.<t # OF UNITS: I
SQ FT PER FLR: ei^G1 # OF STORIES
#OFSTRUCTURES: I # OF FLOORS: I
Exsr LAND DrsruRsrruc prnurrz l""lves pfiro
SQ FT EXISTING IMPERVIOUS AREA:SO FT
leouc [ner CONDO OTHER:
REVISED OATE,g11l12
PROPERTY uSE: EOrrT EnesTAURANT Elfiencerurrre
WATER: ECFPUA MooMMUNITY SYSTEM IIWELL
SEWER: E CFPUA f]CENTRAL SEPTIC L-I PRIVATE SEPTIC
flzoNrNG usE cLAsslFrcATroN
g/otlltr,t U N tW svsrela
". SEPARqTE PERI\,4ITS RTOUIRED F OR [LECT, I\,4ECH, PLBG, CtrAS [QI]IP PIiETABS & INSI:NTS ''
(FOR OFFICE USE ONL'ZONE: OFFICER:
Approval:_ City:_DATE: FLOOD:__ _ BFE+2t=_
AVN
,22.-
in Vio
Comment PERMIT FEE: $_
PHONE *:
PAYMENT METHOD: [CeSn [CneCX leavealE TO NHC) flar,renrcm ExpRESs I ucnnse f] orscoven
SETBACKS: F:_LH:_ RH:_ B:
RECE'I/TD JAN86 2O1i
APPLICAI{T'S IIAllE :
DEVELOPE&:
CONTRACTOR:
ADDRESS:
Iptb -t(tfl
PROIECT ADORESST
SUBDIVISION:
PROPERTY O {ERJS MIiIE:
ohlNER'S AODRESS: Ir',l0 r.t l&a- 0s.1l'tlc
L'
APPL TCATIOI{
t&fiber
(oFflce Use)
o^tE. /-/q-/b
PHOi'E #:
z;;P 29'lof
PHG{E *:40 -\N- bao
CrrY: A;-l*,\",rl7x-t sT:lV zrp' J€tlcl
LICENSE *:6 5 )tr 1
CITY: UJr l.,ri,"1,l.i:-.-sr:NczrP: aSLlt.A-/I Llrc - lS2JaA 3
ta
NEld HANOVER COUNTY BUILDING PERMIT
APPLICA|ION TYPE: RESIDETIITIAL
PLEASE AtiSl.iER ALL QUESTIONS APPLICAALE T0 YOUR PROIECT
"Project ResponsiblUty"
CITY: Ni I lh tv)a-a tt-u-t
sLoA *;7 Lor ",
e
€MAIL ADDRESS:
PRO]ECT CONIACT PERSO :
EXISTII{6 CONSTRUCTION:
PHO E *:
PHO E *:_,,.[f'nlrenrrror f] nrrovarrou E errrur REpArRs n RElocArroil
irEH coNsrRucrrorrr, I rntcr NE]r REsTDENcE o" I morrrox ro Exrsrrr{c REsTDENcE
...PLEASE CHECI( AiD AIIST{IB BELO}I ALL T}iAT APPLY TO YOUR PRO]ECT:
fl nrr ormct _ sF ! orr crnre r sF E poRcH _ sF
SUNROOM SF
f| enrrwouse
-
sr I oe cx
I eooi-
-
sr tr
SF OTHER:
STORAGE SHED SF
SF
TOTAL HEATEO SQ FT:to{2-TOTAL SQ FT UNDER ROOF: b\2- TOTAL aREA SQ rr:q:\z-
ToTAL PRoIECT CoST rr-ess r-orr ? $ 2Of422 # OF SToRIES : t
_ _-...Is Any ELECTRfCAL, PLUiBI G or iECHA{ICAL t{ork Being Oone to the Accessory Structure? f[V"s I Uo
If the project is a Relocation, ls there a ilaturgl Gas Line on the Current Site? flfes fl to
Is there Electrical Power on this Building? pff"t Ilo
PRopERTY usE / occupA cy: {rr*fu FAr,ELy E DUPrE\ f] ro}lir}ousE ,
DEscRIPTIoI{ oF HoR(: <-r'r , "^* (o', .ao or\ -[-. " r,-p. ) .nqa/.ie- qau..'7 -1" \a^c1-
r G;
DlSCLArllER I heiEby ceniry har aX inbrmaraon il ihis Bpptrcalon is I and d wort wit comply wi$
'te
Slate EuibIlg Code aod Er otrcr applicSle Srtsts and bc.l la /
and ordinances and regulalions.lhe NHC Oevebpmonr Services C€n€l wil be nollied ofany cha.lges in 0l. apprc\r'ed aod sp€clficalbns o. ctarlgs h contracbr or
conlacior lnbrmalor'- tdNOTE: Any Work Pertormad Wro tre ApprcpnaE Pemils willbe in Volrallon of the NC St le io Fhes Up To $500.00"
OIS{ER/CONTRACTOR :
'-B..t"' NiJL
(Prlnt rl3re)*t )t )*:t' * * *)t**,i*)t*a*** tt r. *+ * * i** {, ****,1** +r, r* t t* t, ***** *:}*:}**,t** )t**
rs rHE p6opERry Lof4rEp rlr- A FLmDeLATN? E yEs d* u- *,"r. ,*J L-Ae t-*-),*rrirfr"SHfi6fl-oiffl,{f&&-rcrr rorAl AcREsrrrrr*r.rl'r.i/,r-
irEr{ rrnpERvrorrs anrl, "1Z- sq rr Exrsr LAr{, orsruRBrNc o.*rrrrT] rrt do
* *,*** **,***,1** **** *l *rr xx
ATER:
SEUER:
-_Jfl creur ! conmuHrw sysrEM E pRrvArE hrELL I certaar wrll
@creva I crmml sEprrc E pRrvarE sEprrc I courrurrw svsruu
rt* SEPARAIE PERHITS RfQUIREO FOR ELEC], HECH, PL8G, GAS EqJIP, PREFAB5 & INSERTS ***
PAYIIENT llETHoDr flcosx il CHECK (PAYABLE TO NHC)D AI,IERICAN EXPRESS E mcrurso I orscovrr
*'t*,t+***r**i!**++**ti******,t**r****,***:tt 'i ***,I !t 'ri( * * * r, * rr*:t**:(r **:r*:t**,f t * x. ,t +,t i( t *,1:t**,* t(t+**r****r*
(FOR orfI(t usE drLY)REVI5E0 tArE 64/11l12
ZONE: _ OFFICERT SETBACKS: F:- LH:- RH:- B:-
Approval:- City:- DATE:- FLOOD:
-
BFE+2ft=
AV
Coment:
N
PER IT FEE: S +tb
l@+
SIGNATURE :
RECEIVEtT IAN 26 iir.:
ffi
NEW HANOVER COTJNTY BUILDING PERMIT
aPPLIcArIclt rYPEi RESIDENTIAL
PrE^9E Altlr{Ei AlL Q.a.r:ar:s arPLI( aLt T0 Youa P80l:!1
"Proi-ect acsponsibllity,
A,'trtis hn
Tottp-tl:of,
APPLICATlON
tlrbe r
(qft:cr Use)
slru,1,n", I Lr.r-t4-/hAPPLI(,t\T'S flArlE:
DEVELOPER:
PRO] E'T ADOREsS
SUBDIYI5IO:
cofiTqraT0R:
AOOR E55:
ll A,PHotia s:
!(: crrY: ti; t ,'' ''.t: 't
zlPiz9 \o-
^'-r;--'s A : -5s ltllt ',
,t (
ELOCX LNT *
PHOfIE S:q0 -\({t. bao
stt fu', zrP llq}t
HOI{E {r (,,, -'1'5 ) - t6b3
paoae * tltc 5(,Q- 0203
st
'vi,1LI'E$SE *:
CIIY: kJrlni-w-,li--
-'-GE .L-^
ETAIL TCOAESS
SUNn:lilf4
15 THE PROP€L{t yEs
I noor- s; n
:3
\,
P
}L t-alrli-
--/.EXI5TIN6 COfl5TRUCTION: l-..ti',lAl1 E RATIO| ! XTHOVITTOH !erNrnal rrrirns f RELOC-ArIOI
NEr,t Coa,rslRucTloN: ! rn:cr tl] RE5ToENCE o" f, mortror To rxrsrrlr6 RtsrolN(€
'IPLE.AST CHEC( A{O TTSI,]EN 8Erc( ALI 'THAT APDI.Y iC YCUR PRO]EC'I
Uarr ernr:r
-
sF U otr errrcr sr f] mncn
-
sF
SF
I cnegHlouse
-
sr l] oe cx - sF c:Hen: Lsau6i.,:-rit_11g- s r
TOTAL HEATED SQ FT: [+{L IOTAL SQ FT UIDER RMF: b\L TOTAL AREA 5Q TT:!\2--
TOTAL PRoIECT C0ST,,e:rLor : $ .Z#,a:Z> * OF STORIES: t
-r,.ls any ELtCtaI€Al, PLUIB: G o. ,IECHI}{ICAL l,lork SelnB Bone to the Ac.es5ory !:-r.trj.e'L_-.1 Yes Ll tJo
If the proje(t 1s a RelocJtlon, 1s :herc a {.trjt 6as Linc on the curre:rt sltcl efes E xo
fs the.e Ele(t.icrl Poue. on this gui.ldingl No
PR@ERTY UsT / 3CCUP
DTSCRIPTIoN 0f {CRx i
AN(Y:TE FA}II i.Y DTJP L I rownrxouse
tprlnt rId{.t
'1"l- -.
\
olscl,^r,- i" rn)_I _5:o,
- __ rry . "- !,C lrr,l " stJ li, n
O^[lER,i CoiJTRACTOR : _':5 EL'-AIJi*
-
EXIST iN6 I!D
RTY LO(ATED Ifl A FLOOOPLAIN?
',H;a,l;!ip,$Mu. *,,
ERvrous AREA: =?-- tq t,
\L A( . I Ur, Eor
E:l L/'' *---"t!
b?br'reNEl,'l L.tr
l,J'll-::__ lA f ccmunrrv svs'rr-r I pR]vATE uELL ! cer;rral wrll
srtlrj|t WcFpu^ f] crttrn,rl srnrrc fl PRTVATE sEPrra f] cotl,nnlrv svstrm
..' -ii,,:,,.'t liji! ! ii ! .-)irl,r1jl lon r: a' :.i'lr t,L8nr liri i:{,ir': r;ilAiiJ & ,-,ili
payrlE$T llErHoo: l].osn Dc*rc* (PAYAaIE 10 tlxc) E$trrcrit srpnrss C *1,,*ti:aovtR
(rci oFl:cE usl u{! r)r E.:: i Ddr.r/r1/r)
zone r fu$orrtc.o,
App.oval:=-_ CitY:
$1F1*,N\n.,:A!lf s:--.lLllF jcr-(?'CI$
/ .':lL
)i 2 -l.lV rtrxo --E-E16--fl
PERUIT FEE: t__e
s it no\UA 1cbs{,
"tA
.-r 1ro Vt fvtS,,\al
bu-
'tfu.,,tits.n- I ri'<-ACc.rrent:
{'T',n
N$
-1w4-
l,Ad,'., tnn.r,'., nL,
P:---:- CC i-'-- ----- t:
t.^1. .^.^
SI6I.IATURE: