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Please use blue or black ink to fill out this form. Permitn #: PTC <br /> ��1c-q"."-- BUILDING PERMIT APPLICATION t��Ai� _ � O <br /> PEACHTRCITY 153 Willowbend Rd, Peachtree City, GA 30269 Office Use Only <br /> P: 770-487-8901 F: 770-631-2552 <br /> WWW.PEACHTREE-CITY.ORG <br /> PROJECT TYPE JOB SITE ADDRESS DATE: a / 'Z / ZQy 4 <br /> ❑Residential ©Tion-Residential -' RL 9 '1li 5 Ere. L i <br /> (� Z.� Estimated Value Labor&Materials <br /> ❑ emodel USE i deck,etc) <br /> $ 8o�006 <br /> ii�emodel Repair❑ ., tock <br /> ❑Addition 0 Basement Finish <br /> Name 5A 1 bN LrG-i-t rsm G- 1).1 A i Sitr.1 „ Firm / eimjjeAr 6A/5,eue-/'G'A/1Z <br /> r W Address i i 2.r i{kJ 4 '1 q S Q Address//�S/ / t1 Z N/ <br /> C3 City, State, Zip PeA-CI-Pt--eee G �J 30269 u og City, State, Zip ' Veb' /fie �u 30Z/y <br /> cc O Phone 11 1()-LI 84 -'leo0 Fax � Z Phone Lioq-84,7- S.0i Fax 710.11 q-CP3 <br /> O. Email 0,Mt- J5t(I A EA40lJ •CDWL u License # R?e0000379 <br /> Primary project contact? 0 Yes p-No Pi:many pi oiect contact; p-?es 0 No <br /> u Name D A•I =D KENIr FENCE HOA <br /> TYPE MATERIAL Owner is responsible <br /> M Address Ov,ce 5 C,T- QiZoOlCS 6A 3o02-5— 0 Commercial 0 Wood 0 Brick/Stone for home owner <br /> association approval. <br /> V Phone 7"70-1160- 74/cis— Fax ❑Industrial 0 Metal Black/Green Vinyl Do you have a letter <br /> of approval from the <br /> < b Pt4-1 i` D c l*K .O 5 5 V.. e r,y� ❑Residential ❑Other HOA attached? <br /> Q Email ❑Pool Fence Height 0 Yes 0 No <br /> 4d t! L©Fr- 4CEA- cm gX 1 s-i"tN c— o APPROVALS Building Height: Total Heated sqft: <br /> LL <br /> 03 t 'PALE iN ii-k T(AJO or•PXcG' N 0 Sewer #of Floors: 22ac <br /> IX ILI H 0 Septic #of Bedrooms: <br /> UIO 0 Water #of Baths: <br /> Total�" ',LI' Total Unheated sqft: <br /> G 0 FCEH approval date: #of Fireplaces: <br /> a _/_/ Basement? 0 Yes 0 No <br /> *FCEH-Fayette County Environmental Health Dept-770-631-0743 <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 further certify that all construction will comply with the International Building Codes. <br /> Signature of Owner/Agent/Applicant: u`�� Date /2/Z/f+/ <br /> Print Applicant Name: 'V R:421 // 77.2/3 de Phone#: /`,e7/"�P�-<-e 9 -- <br /> FOR OFFICE USE ONLY Stormwater Utility Bill up-to-date? Construction Type: <br /> ❑yes ❑No Occupancy Type: <br /> Application Accepted by: Porn Plan Name: Plan on File? <br /> 0 Yes 0 No <br /> Approved by HOA? 0 Verbal approval 1Jr' ' "` ",L, <br /> HOA 0 Yes 0 No 0 N/A 0 Written approval <br /> PLANNING&ZONING ENGINEERING <br /> Zoned: Conditions: ❑Yes 0 No Approved LDP? Conforms with LDP? Project in Floodplain? <br /> ❑Yes-see attached ❑Yes 0 No ❑Yes 0 No ❑Yes 0 No <br /> "'' ,cor Additional Impervious Area: Total new impervious area: <br /> Setbacks: 2 <br /> 0 Yes-(fallout back section) 0 No ft <br /> 'c I Aui, . _. ❑ D r,C D,It•e_ Hl1,2r i y `.oJ ed by ❑Approved ❑ D,1,:_c1 Aat <br /> PERMIT: LDP: FIRE MARSHAL: PLAN REVIEW: CO: TOTAL: <br /> $ 210 $ $ $ .405 $ $ <br /> _/_/ —/ / —/—_/ IL--, 2 / tv /_l —/—/ <br /> Builag\per It )lication .I ri', www.peachtree-city.ora <br /> Revised 1/2012 Fax: 770-631-2552 <br />