66173D - Garalis

CAMA / ❑ DREDGE & FILL `'Z \✓ NO o ' 66173
A B
"ENERAL PERMIT Previous permit #
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC �GT%
f RUles attached.
Name ., Project Location: County ��I� 11SVrtlC Lc.
t nn Street Address/ State Road/ Lot #(s)
State �� ZIP V ��C '�{ / i !A r" �t it � t`
(112) (0�5g E-Mail Subdivision F�
;d Agent i(� i� City 1 �c, 1 UuG ZIP D (
ElCW ❑ EW ❑ PTA ')ds Phone # fp 17"10 _ ' 1 1113 River Basin
❑ OEA ❑ HHF ❑ IH ❑ URA ❑ N/A
Adj. Wtr. Body 4 Ak (nat n
❑ PWS:
fes / no PHA yes no
Closest Maj. Wtr. Body
Project/ Activity 0& r1' ( 'V ' �W a A
(Scale:
:k) length
tform(s) --.. r. T .. - _ _ i -
'latform(s) 1 T I . t .
igth
nber
LRiprap length x
distance offshore
x distance offshore o
annel 1
iic yards
ip
se/ Boatl
■No
lm
vI
A\1■\ ■Fw_- .i1■■ ■■■■
im
ms W'n I r,
6m. N n
. MWERVINEEMEMMINE
ONO
. ■■■!��\■■■►.�!!11:!!■■■■�■■fin,'®MOM
■■■NOMINEE
■■
■■■i■■■■■■■■■■NEE■■n■■■■

11/12/2015
—-
11/12/2015
11/12/2015
11/12/2016
11/12/2015
11/12/2015
11/12/2015
1 1 /13/2015
11/13/2015
11/16/2015
11%16/2015
11/16/2015.
11/16/2015
11M6/2015
11/16/2015
11/17/2015
11/ 77/2015
11/17/2015
11/17/ 0015
11/13/15 Allied Marine Contractors LLC -
11/13/15 Richardson Construction
11/13/15 Carolina —Marine Construction Inc
11/13/15 Clements Marine Construction Inc
-- — —
11/13/15 Cityf W oilmington
11/13/15 Eduardo San Miguel
11/13/15 Charles or Linda Honda
11/16/15 Carolina Coast Contracting, Corp
11/16/15 Coastal Land Design
11/16/15 Allied Ma_ nine Contractors LLC
11/17/15 Charles Riggs & Ass_oc.
11/17/15 Charles Riggs & Assoc.
I /17/15 St. Moritz HOA Inc
11/17/15 Charles Riggs & Assoc.
11/17/15 Sunset Dock Assoc
11/17/15 County of Brunswick
11/17/15 Benjamin Spence Albright
11/17/15 Money Order from Brandon Grimes
11/17/15 Southeastern Coastal Construction Co
!Scott Tucker
-
Brian Hennessee _
Federal Point Yacht Club
Ray Sito
—
same
same
same
470 Anderson, LLC
James Taggart
Hays Lambert
Michael & Becky Steed _
Sandy Feet, LLC
same
Dennis & Mary Backer (Booker)
same
same
same
Chris Lutterloah
Robbie Brooks
b of A
BB &T
First Bank
First Citizens Bank
B of A
PNC Bank
Navy Federal Credit Union
B of A
B of A
B of A
First Citizens Bank _
First Citizens Bank
North State Bank
First Citizens Bank
First Citizens Bank
BB &T
BB &T
Wells Fargo Bank
First Federal
6182
$200.00
GP 66187D
9922
$400.00
major fee, 910 Basin F
3957
$250.00
major fee, 462 Causev
324120
$100.00
$600.00
renewal fee, MP 81-12
GP 66197D
1007
4012
$600.00
GP 661150
7000
$100.00
minor fee, 179 Topsail
5123
$100.00
minor fee, 230 N. And,
7996
$200.00
GP 66215D
14283
_ 14265
1563
14264
1103
742787
18168
59183420956
9640
$100.00
minor fee, 135 Sound
$100.00
$.100.00
$100.00
$536.00
$400.00
$200.00
$200.00
$400.00
minor. fee, 111 Permui
minor fee, 4110 Island
minor fee, 614 Hampt,
NOV 15-18D, $250, $:
GP 66219D
GP 66216D
GP 66217D
GP 66218D
11/17/2015
11/17/15
Lee Thornton
Lee Thornton
Coastal Bank and Trust
992
$100.00
minor fee, S. Lloyd Lt
11/20/2015
H5 Construction LLC
Richard James
BB &T
1367
2303
1000
1236
$600.00
$200,00
$400.00
$200.00
GP 66170D
GP 66172D
11/20/2015
Holden Docks & Bulkheads
Michael Huskey
CresCom Bank
11/20/2015
Frederick H. Kart
same
BB &T
iGP 86171D
11/2012015
Logan Marine LLC
SEL Property Investors LLC
Coming Federal Credit Union
'GP 88220D
11/23/2015
Money Order from Dixon Broadfoot
Burmah Broadfoot
Wells Fargo Bank MO
17-269805108
11712
$200.00
$400.00
GP 88221 D
11/23/2015
Mike Milligan Painting
George Garalis
BB &T
GP 66173D
nJ
-1'
t�
V)
v

C Division of Coastal Mgt. Habitat Impact Computer Sleet
plicant: C�e C VAL& s Permit #: �-
ite:
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
bitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Dredge ❑ Fill Both ❑ Other ❑
SD
Dredge ❑ Fill Both ❑ Other ❑
v
GDredge
❑ Fill El Both ❑ Other
l Dbo
, l
" v
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill 171 Both ❑ Other ❑

\1 1, i 2 4 118 F. !
AGENT AUTHORIZATION FOR 9AMA Fj; MIT APPLJCATIQ.N
_
Narne of Property Owner Applying for Permit:
Mailing ad.dress, c
uovp
Phone Number:
I oertify'fkat I have authorized JW I
Age rt/pontractor
to act on my behalf, for the purpose of applying and Otainin all LAMA permits
necessary for the proposed development of,
atmyproperty located at_4,1 kit (tl kr'l
in Co
'This. certificatio n is valid through
Date
(Pr'operty Owner Information)
-S ign, 9 t Me
6 C
P&ti Type Name
Me

�
k!
Mn
t�

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: 65ZW -
Address of Property:
(Lot or Street #, Street or Road City & County)
Agents Namo #: Mailing Address:
Agent's phone #: ld 4 e_
l P A rro
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are roposing. A description or drawinq, with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION /
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be s t
back a minirnum distance of 15' from my area of riparian access unless waived by me. (If yc;. l- `
wish to waive the setback, you must initial the appropriate blank below.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro arty Owner Information)
Signature-`
- (C)t i s
Print or yp a Name
ailing Address
(A acent Tarty Owner Information)
L0"U"
K
_� 1Print or Type Name
aHit Address
v \._ ll . t( L -1,

ENT RIPARI
I hereby certify that I own property adjacent to
ER STATEMENT
's
>. dame ofFroperty Owner)
property located at /`� 1 r2a .�
�� (Address, Lot, Block, Road, etc.)
on in !n� f-- l��--,C, N.C.
(Waterbod y) (City/Town and/or County)
The appl an has described to me, as shown below, the development proposed at the above locatic
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
,
&AIIrlKI
I understand that a pier, dock, ooririg pilin , breakwater, boathouse, lift, or groin must be set bad
minimum distance of 5' o my area riparian access unless waived by me. (if you wish to wai
the setback, you must i iate blank below.)
I do wi§Kto waive the 15' setback requirement.
- I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Property Owner Information)
�1GIr I e 5 { /liie1 , J�
Print or Type Name
Mailing Address
Print or Type Name
D, I l
Mailinn .4Hf1 ac.c

I hereby certify that I own property adjacent to
me
property located at
I
on �n
—�� (Address, Lot, Block, Road, etc.)
, in — �:t�n__f z2g a , N.C.
(Waterbody) (City/Towand/or County)
The applicant has described to me, as shown below, the development proposed at the above locatic
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
I understand that a pier, dock, ooririg pilin , breakwater, boathouse, lift, or groin must be set bac
minimum distance of 5' o my area riparian access unless waived by me. (If you wish to wa
the setback, you must i ate blank below.)
I do wi to waive thel 15' setbac requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
AAnilin AAA -
(Adjacent Prop. Owner Information)
Si nature
Pri'�or Type Name '
x3. -f L47
AA -:I:-- AJJ____

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
w
Name of Property Owner:4:31�-40�
Address of Property:
(Lot or Street #, Street or Road, City & County)
"�v
Agent Name * Mailing Address: y T
Agent's phone #: d r,. l
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be Provided with this letter.
1� I have no objections to this proposal. I have objections to this proposal.
If you have objections to what Is being proposed, you must notify the Division of Coastal Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if you have been notified by Certified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (if you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro erty Owner Information)
Signature-'%%� (
4[� r r p I, t4 SLY_ l S'
Print or 7ype Name
(Adjacent Proper. r Information)
ignature
Print or Type Name
ailingailing Address
Mailing Address

� arv3'
�;
LOCATION
OWNER:
CONTRACTOR:
Town of Sunset Beach
RESIDENTIAL BUILDING PERMIT
700 Sunset Blvd. Sunset Beach, NC 28468
Phone:[phone] FAX:[phone]
DATE ISSUED: 02/19/2016
L-11 CANAL-B SUNSET BEACH PLAT H/358
411 MARLIN ST
GREALIS GEORGE E ET BARBARA A
970
WEST ENTERPRISES
P.O. BOX 990
P.O. BOX 1532 SHALLOTTE NC
CONCORD, NC 28026-0990
PHONE: [phone]
SUBCONTRACTOR ID/NAME
DISTRICT
LOT
it
PERMIT #: 2016- 1
TAX MAP PARCI
256NA006
ZONING DISTRI
BR-2
TOTAL VALUAT
$ 20,000
SUBCONTRACTOR TYPE
TYPE CONSTRUCTION: BULKHEAD OCCUPANCY GROUP: SINGLE FAN
FEE CODE FEE
RESIDENTIAL ALTERATIONS/RESIDENTIAL ALTERATION 180.00
TOTAL PAID: 0.00 TOTAL AMOUNT: 180.00
Z-y
REMARKS: REPAIR BULKHEAD. THIS PERMIT REPLACE PERMIT 12697 WHICH HAS BEEN REVOKED.
NOTES: PLANS AND PERMIT MUST BE ON SITE AT ALL TIMES.

o
Town of Sunset Beach
RESIDENTIAL BUILDING PERMIT
700 Sunset Blvd. Sunset Beach, NC 28468
U Phone:[phone] FAX:[phone]
DATE ISSUED: 02/19/2016 PERMIT #: 2016- 1,
I (We) agree to conform to all Federal, State & Local codes and ordinances. All materials will be removed proir to the issuance
Certificate of Occupancy. I (We) certify that all the ground floor or area under the Base Flood Elevation is to be used for storag
purposes only, and that no habitable areas will be allowed. No bathrooms, bedrooms, electricaL, plumbing, or applaiances, etc.
Structures built in the "V-Zone" will have breakaway walls that must be certified by an engineer. "A -Zone" must have hydro-sta
venting (FEMA).
I (We) certify that the structure will be placed on the lot and will be conforming to all the set -back lines, yard requirements, and
height limitations, required by the Sunset Beach Zoning Regulations and will comply with Coastal Area Management requireme
Expiration: A permit shall expire six (6) months, or any lesser time fixed by local ordinances, after the date of issuance if the we
authroized by the permit has not commenced. If after commencement, the work is discontinued for a period of twelve (12) mont
the permit shall expire. In either of the above cases, an inspection must have been called for to verify continuation of work.
The Following Items Must Be On Site:
* Approved Permit Box
* Building Permit Must Be Posted
* Port -A -Potty
* Approved Trash Container
* Silt Fence Must Be Installed Around Peritmeter of Construction Site
* Per Town Ordinance 94.02: Work Cannot Commence Before 7:30 am to 8:00 pm Memorial Day to Labor Day and 7:00 am tc
8:00 pm Labor Day to Memorial Day. No work may be commence on Sunday anytime of the year.
(This section for multiple trade permits only)
MECHANICAL CONTRACTOR:
(Print Name)
ELECTRICAL CONTRACTOR:
(Print Name)
PLUMBING CONTRACTOR:
(Print Name)
GAS CONTRACTOR:
(Print Name)
NOTICE:
*** Work for scheduled inspection must completed prior to scheduling inspection.
*** A re -inspection fee will apply to any disapproved inspections.
, L'�I__ li,s
--,-
/DD IN= XT A A A

a..,
v
DATE ISSUED: 12/15/2015
Town of Sunset Beach
RESIDENTIAL BUILDING PERMIT
700 Sunset Blvd. Sunset Beach, NC 28468
Phone:[phone] FAX:[phone]
LOCATION L-I 1 CANAL-B SUNSET BEACH PLAT H/358
411 MARLIN ST
OWNER: GREALIS GEORGE E ET BARBARA A
CONTRACTOR: 561° C 1
MIKE MILLIGAN a t J g�
5440 SPARROW ST SW
OCEAN ISLE BEACH, NC 28469
PHONE: [phone]
SUBCONTRACTOR IIYNAME
PERMIT #: 2015- 1,
DISTRICT TAX MAP PARCE
256NA006
LOT ZONING DISTRI(
I I BR-2
TOTAL VALUATI
$ 12,500
SUBCONTRACTOR TYPE
TYPE CONSTRUCTION: BULKHEAD OCCUPANCY GROUP: SINGLE FAM
FEE CODE FEE
RESIDENTIAL ALTERATIONS/BULK HEAD 150.00
TOTAL PAID: 0.00 TOTAL AMOUNT: 150.00
REMARKS: CONSTRUCT NEW 50' VINYL BULKHEAD PER CAMA AND ENGINEERS DRAWING.

�C-1wly car Town of Sunset Beach
RESIDENTIAL BUILDING PERMIT
700 Sunset Blvd. Sunset Beach, NC 28468
(j Phone:[phone] FAX:[phone]
DATE ISSUED: 12/15/2015 PERMIT #: 2015- E
I (We) agree to conform to all Federal, State & Local codes and ordinances. All materials will be removed proir to the issuance
Certificate of Occupancy. I (We) certify that all the ground floor or area under the Base Flood Elevation is to be used for storage
purposes only, and that no habitable areas will be allowed. No bathrooms, bedrooms, electricaL, plumbing, or applaiances, etc.
Structures built in the "V-Zone" will have breakaway walls that must be certified by an engineer. "A -Zone" must have hydro-sta
venting (FEMA).
I (We) certify that the structure will be placed on the lot and will be conforming to all the set -back lines, yard requirements, and
height limitations, required by the Sunset Beach Zoning Regulations and will comply with Coastal Area Management requireme
Expiration: A permit shall expire six (6) months, or any lesser time fixed by local ordinances, after the date of issuance if the we
authroized by the permit has not commenced. If after commencement, the work is discontinued for a period of twelve (12) mont
the permit shall expire. In either of the above cases, an inspection must have been called for to verify continuation of work.
The Following Items Must Be On Site:
* Approved Permit Box
* Building Permit Must Be Posted
* Port -A -Potty
* Approved Trash Container
* Silt Fence Must Be Installed Around Peritmeter of Construction Site
* Per Town Ordinance 94.02: Work Cannot Commence Before 7:30 am to 8:00 pm Memorial Day to Labor Day and 7:00 am to
8:00 pm Labor Day to Memorial Day. No work may be commence on Sunday anytime of the year.
(This section for multiple trade permits only)
MECHANICAL CONTRACTOR:
(Print Name)
ELECTRICAL CONTRACTOR:
(Print Name)
PLUMBING CONTRACTOR:
(Print Name)
GAS CONTRACTOR:
(Print Name)
NOTICE:
*** Work for scheduled inspection must completed prior to scheduling inspection.
*** A re -inspection fee will apply to any disapproved inspections.
r
inn IXT-r KT A A err-,

Town of Sunset Beach
Y 2015-2016
INSPECTION REPORT
;RMIT/DATE
ISPECTED OWNER/LOCATION INSPECTOR/CONTACT/PHONE
12697 GREALIS GEORGE E ET BARBARA iCINDY NELSON
>./19/2016 411 MARLIN ST
SUNSET BEACH, NC 28468 PHONE
SUBDIVISION/PROJECT:
CONTRACTOR: MIKE MILLIGAN
MOBILE:
TYPE OF GROUP/
INSPECTION STATI
GENERAL
COMMENTS
CONTRACTOR PHONE: [phone]
2/19/16: PERMIT REVOKED AS ORIGINAL CONTRACTOR IS NOT DOING THE WORK AS SPECIFIED. A
CONSTRACTOR APPLIED WITH A NEW INCREASED PROJECT COST AND NEW PLANS WHICH ARE
DIFFERENT THAN WHAT WAS ORIGINALLY SUBMITTED. NEW PERMIT 912862
TOTAL ALL: I

N:
Brunner Associates LLC
Edward Brunner P.E.
go Shoreline Drive West
`,,, 11111 I'll,
%Pj H CA,%C
`� .PpFESSipti
�Q
SEAL
29208
IN ESP.
qR B
113IO

- -0-' A f 4 / -P /,v C. Arr-
,P, X -a- e 9�
WIIA-4,054, (7-YlalIC A -I-)
V1A,oIY4 3as
s'"'ear oe-fie'eZ42,
/.2
GAAAf
I &,q . .........
SEAL
29208
1?, 4q-
1641
so ates C
Brunner Associates B er As
pi Edward Brunner P-E-

-�-1�e -roww a f sl� KSet Beach
700 Sunset Boulevard North . Sunset Beach . NC . 28468
Phone: [phone] or [phone] • Fax
(910) 579-1 40t`' "
DEC 112011
i
Permit Application: TRADES"
— ----
Permit Number: i j, Le Q I
Tax Parcel Number:
Project Address: 1
S
Property Owner Name:
Property Owner Mailing Address:
(m,a alogel
Property Owner T,61ephone Numbers (s):
Home: S 79Cell:
1-// ,g S--Za—
Project Information
Structure Use: Residential ❑ Commercial
❑ Governmental
Project Type: ❑ Building ❑ Electrical ❑ Mechanical ❑ Plumbing
Description of Project: SO C �p
Total Project Cost: $ Z J
Applicant/Contractor: 1�1)
Address:
City: C f ;/� 7— State:
-V
Phone: Cell: CVC) 4q*,', 3 Fax:
NC License#: Class:
Expiration:
Email Address:
Additional Contractor:
Address:
City: State:
Zip:
Phone: Cell:
Fax:
NC License#: Class:
Expiration:
Email Address:
Date:-

>0 CAMA /f0 DREDGE & FILL N? 66173 A B
GENERAL PERMIT Previous permit#
ONew OModification OComplete Reissue El Partial Reissue Date previous permit issued
uthorized by the State of North Carolina, Department of Environment and Natural Resources tt
the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC f i
1A Rules attached.
licant Name ;• Project Location: Countylf Ji` iGZc
res{ Street Address/ State Road/ Lot #(s)
A.i ' State if ZIP �•� _ "f ' '� �l li. xi. AN
ne # (-L) �2 s S `i `4 E#-Mail Subdivision
iorized Agent + I� 1 L-�ti' (City ���'^^ tiC� ZIP
❑ CW ❑ EW ❑ PTA S t TS P `d!hie` # i T. )`'j " " 1 1.�.2) River Basin
,(Sjd ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A Adj. Wtr. Body. �i'k �
❑ PWS: •
V: yes PWS:(no PNA yes no Closest Maj. Wtr. Body
le of Project/ Activity
(Scale:
!r (dock) length
ed Platform(s)
gating Platform(s)
s) ger pier
oin length
number
!�`� t �'Zl.�..I�•' � � � I I i I I I _I_I '—_I—I I_ _ I
Ikhead/Ripraplengthi�--�-
--Tj 6:-1•-�' ��3�1..tti.�;= '�I_ '� —1.. _ r I—l_���_I '�--?-�—' � I _` _ __I_� __' �`��;`-L
avg distance offshore
max distance offshore
On, channel
i
cubic yards_
at ramp
athouse/ Boatlift
ach Bulldozing '
herl)`.>41,
-4
)reline Length=' I I i
v: not sure yes
iratorium:
n/a yes no J
atos: ...yew
liver Attached: yes Cno./I
wilding permit may be required by: _
Jote Local Planning jurisdiction)3
,tac/ Snarinl C_nnr itinne u
I%"_— I —I _!I— I I I I I I l
❑ See note on back regarding River Basin ru

\VN[
The Toww of 5l-twset Beach
r- 700 Sunset Boulevard North . Sunset Beach . NC . 28468
Phone: [phone] or [phone] • Fax: [phone]
Permit Application: TRADES
Permit Number: �' (�2-
Tax Parcel Number: ti',,+ C L')t,>
Project Address: 4 // ,
Property Owner Name:S
Property Owner Mailing Address:
Property Owner Telephone Numbers (s):
Home: Cell:
Project Information
Structure Use: Residential ❑ Commercial ❑ Governmental
Project Type: ❑ Building ❑ Electrical ❑ Mechanical ❑ Plumbing
Description of Project: 5e Q 1,14 A/ 7ePA I
Total Project Cost: $
Applicant/Contractor: i xl,K -S
Address. PCB
City: : `)4.0. i/o F- State: AiJL Zip: fs 9-5'
Phone: ' o �/- JC -- 9- Cell: Fax:
NC License#: -,�/.. - 7� Class: Expiration:
Email Address: `" , c.k. C s ; 4,-,c)0' 61."-A
Additional Contractor: i
Address: t
City: State: r Zip:
Phone: Cell: 0 Fax:
NC License#: Class: ,L,vi.jw,, Expiration: -14
Email Address:
Date: