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Please use blue or black ink to fill out this form. Permit #:
<br /> -41"1"---- APPLICATION PSFICO — RS
<br /> BUILDING PERMIT Office Use Only
<br /> PEACHTREE CITY 153 Willowbend Rd, Peachtree City, GA 30269
<br /> P: 770-487-8901 F: 770-631-2552
<br /> WWW.PEACHTREE-CITY.ORG •�t^ '
<br /> /PROJECT TYPE JOB SITE ADDRESS DATE: 24 ij 72 6
<br /> Residential ❑ Non-Residential Address: Estimated Value(Labor&Materials):
<br /> 44.,,,ai.1
<br /> 0 Commercial 0 Industrial ub Na e g ,� Lat�� . (4 Q GO
<br /> •
<br /> Ore Name (lig/ ;_:-00.-1-1,01-721-46,p € i .• J (2 Firm( % Q -dvA �7 i `l'-s •
<br /> 12
<br /> Z Address . N` T k_95371)
<br /> g v Addres04C7� 5P
<br /> Z0 City, State, Zip �/" 7 ' (1 • . �'1.* 0.69 •Z g City, State, Zip LSC/ c 4 %e'- Co?
<br /> r OW !��' �!1 Fax // - w Z ■ ' /// �;
<br /> Phone - c7 Phone 40' --
<br /> CO I Email ��l.i /� • _i.'"/_�.r-- �:L-�� _ �_. .N7M( � / _--
<br /> Email �L,/,/ n //_�_.. - iii �^
<br /> i
<br /> '&4Z-ft. awe- FENCE HOA
<br /> V Name TYPE/MATERIAL FENCE HEIGHT__ ' Owner is responsible
<br /> w Address ,. • '. .�/ =�• =�' 0 Commercial ❑ Wood ❑ Brick/Stone for home owner
<br /> "43association approval.
<br /> = Phone Tail Fax Fax ?�Q•�0i` 0Industrial ❑ Chain link blk/grn/brn vnyl Do you have a letter
<br /> ct 0 Residential 0 Powder Coated Aluminum of approval from the
<br /> HOA attached?
<br /> < Email 0 Pool 0 other 0 Yes CI No
<br /> / v
<br /> • O APPROVALS Building Height: �O Total Heated sqft:
<br /> i
<br /> m (- �' N Sewer #of Floors: : Q�1.
<br /> in _aViv-91-0�C F- 0 Septic #of Bedrooms: a
<br /> We ��V W ❑ Water #of Baths:
<br /> Z,,
<br /> w' n Total Unheated sqft:
<br /> a 4 0 FCEH approval date: #of Fireplaces: I���
<br /> 5 D. _/_/ Basement? 0 Yes No pG ,
<br /> nUP.q
<br /> This permit becomes null and void if work or construction authorized is not commenced within 6 months or if construction or work is
<br /> suspended or abandoned for a period of 6 months at any time after work is started separate permits are required for electrical, plumbing,
<br /> heating,fireplace ventilation,air conditioning.
<br /> I hereby certify that I have read and examined this application and the information provided herein is true and correct. No changes shall
<br /> be made from that which is stated in this application,or in attached plans and specifications. Granting of a permit shall not be construed
<br /> as a permit for or an approval of any violation of the Building Code or any other state or local law regulating construction or the
<br /> performance of construction. I f er'0 ,e- •'- th. all construction will comply with the International Building Codes.
<br /> Signature of Owner/Agent/Applicant: r` / Date// -/j-16
<br /> Print Applicant Name: tLl • Alta IC:IC ---loyal Phone#: 9,0• 44iOCg(5,
<br /> FOR OFFICE USE ONLY Stormwater Utility Bill up-to-date? Occupancy
<br /> ❑Yes ❑ No
<br /> /S:
<br /> li-i-tip-) PEl Yes 0 No
<br /> lan on File?
<br /> HOA Approved by HOA? 0 Verbal approval •
<br /> 0 Yes 0 No 0 N/A 0 Written approval
<br /> PLANNING &ZONING ENGINEERING
<br /> Zoned: Conditions: 0 Yes 0 No Approved LDP? Conforms with LDP? Project in Floodplain?
<br /> 0 Yes-see attached 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No
<br /> Front viae Additional Impervious Area: Total new impervious area:
<br /> Setbacks:
<br /> ❑Yes-(fillout back section) 0 No
<br /> ft2
<br /> _cuing checked by 0 Approved 0 Denied Date Engineering checked by 0 Approved 0 Denied Date
<br /> PERMIT: LDP: FIRE MARSHAL: PLAN REVIEW: CO: TOTAL:
<br /> �2 S3 - $ $ $ )50 - $ $
<br /> —/ _,
<br /> , ,
<br /> 2 i .(v ;j y ) (D q —7 www.peachtree-city.orq
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