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� o•�-�o��� ciry ot�ephymiiis Permit Application Fax 813-780-0d21 <br /> Butlding department <br /> ts R�ceived ` rj Phone Cantaat for Parmittin i `")� � <br /> rner's Name �Owner Phong Number � �`��� ' y�� <br /> ►ner's Address , �� � L...- �� 'lr"�- Owner Phon�Number � ! �� <br /> a Slmple Titleholder Name �— � Owner Phane Number � <br /> e Simple Tittehotder Address <br /> � �� �� <br /> B ADDRESS � ��"� lOT# ', <br /> 'BDIV1510N ��� � PARGEI.ID# <br /> (OBTAINED FROM PROPERTY TAX NdTICE) { <br /> )RK PROPOSED e NEW CONSTR 8 ADD/AL7 � SIGN Q Q DEMOLISH <br /> 1NSTALL REPAIR <br /> .OP88ED tISE Q SFR Q COMM � 07HER <br /> PE OF COMS7RUCT10N C] BL4CK Q FRAME � STEEL Q � <br /> SCRIPTIQN OF WORK � �-G.� L.1' ''R- � �.�.�✓ <br /> �ILDING SIZE �� � SQ FOOTAGE HEIGHT ��_� <br /> QBUILDING �� VALUATIQN QF TOTAI CONSTRUCTIQN I <br /> QELECYRICAL ��� AMP SERVICE Q PROGREBS ENERGY [� W.R.E.C. <br /> QPLUMBING �� <br /> � � �� VALUATtON dF MECHANiCAL tNSTALLATION <br /> ECHANtCA� $ _-- <br /> QGAS � ROOFING Q SPECIALTY [� OTHER <br /> 1tSHED FLOOR ELEVATiONS �—� FLOOD ZONE AREA QYES NO <br /> ILDER COMPANY <br /> iNATURE REGiSTERED Y/ N FEE CURRE� Y/N <br /> Address License# �— ii� <br /> :CTRICIAF! COMPANY <br /> �NATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address i llcense# �— � <br /> )MBER COMPANY <br /> �MATURE f2EG1STEFtED Y 1 N FEE CURRE� Y I h1 <br /> Address License# � � <br /> GHANICAL COMPANY '✓'�n.�- <br /> NATURE �� -'��� REGISTERED Y/ N FEE C RER Y I RI <br /> Address License# �- � <br /> tER COMPANY <br /> NATURE REGISTERED Y 1 N FEf GllRRE� Y J N. <br /> AddrBSS Lfaense# �� i � <br /> tIDENT1Al Attach{2)Piot Pians;(2)sets af Buitding Pia�s;{1}set of Energy Forms;R-O-W Permit far new cx�nstrucUan, <br /> Minimum ten(10)working days after submitta!date, Required ansike,Construction Plans,Starmwater Plans w/SIIE Fence instatied, <br /> Santtary Facitides&t dumpster,Stte Woric permit for subdivisiansparge projects <br /> ANtERC1At._ Attach{3)complete sets_of BultdingP_tans-ptus a life Safety Page;{1}set of Energy Forms;R-O=W-Permi#for new constnuc8on. <br /> � Minimum ten(10)working days aRer submittal date. Required onslte,Constructlon Plans,Starmwater Plans w!SHt Fenoe ins#aAed, <br /> Sanitary Facliitles 8 1 dumpster.Slte Wark.Permit for,all new projects.All commercial requirements must meet campliance � <br /> N PERMt7 Attach{2}sets of Engineered Plans. • <br /> ""PROPERTY SURVEY requtred f�or al!NEW construction. � �- <br /> ctlans: <br /> Fill out appflcallon completely. <br /> Owner&Contractor sign back of appifcation,notarized <br /> tf ov�r�250d,a Notice af Commencement Is required. (A/C upgradas oqer�7500) <br /> Agent{for the cantractar}or Power of Attomey(for the owrier)woutd be sameone wifh notarized letter from owner authorizing same <br /> :R THE COUN7ER PERMI'RtNG ` {Front of;Application Oniy)a �, , ', { <br /> iofs if shingles Sawers ServEce Upgrades_,AlG � ;t Fences��(PiotlSuiireylFootage} <br /> D�iveways-Riot over Counter if on public roadways..needs ROW � ' � <br /> , .�..._ .. - �;-. ._,.. .... .,..�., ,. <br />