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_._— ------ - <br /> -_ – <br /> _._ .__ ____ �.,uy vr 4epnymms r'ei'mit Rpptic2tiott Fax-813aea-aa2 <br /> Bullding Department <br /> i. <br /> i <br /> Date Received" � - <br /> i'hone Contaot for Permltt4n <br /> OwnePs Name " c..,9 � i'�- �c_.- -ec_Owner Phone Flumt�er �'i"'S- Z. �S '�i.S } <br /> Q��°CcrtS.Pc� � '� <br /> CJwner's Address � � Qu�mer Phone Numbcr <br /> Fee Simpie Titleholder Nam� Owner Phone tdumber <br /> Fee Simpie titieholder Address <br /> JOB A <br /> DDRESS � LOT# � 1 <br /> SUBDlVISION � Q , ,� / ,� � PARCEL1q# <br /> (OBTAtNED FROM PHOPERTY 7AX NOTIG@) <br /> WORK PROPOSED e NEM►COIdSTR 8 ADD/AL7 � SIGN Q � DEMOLISH <br /> iNSTALL REPAIR <br /> PROPO5E�U8E [� SFR [� COMM ' �„� t?TNER <br /> TYPE OF C�'1NSTRUCI'ION Q BI.00K L] FRAME � STEEL Q <br /> DESCRfPTi0�1 OF WORK `'� <br /> BUILDINti SIZE � � SQ FQOTAGE�_,�� HEIGHT ��,_„� <br /> QBUILDING � ���Q 6 v*� VALUA710N OF tOTAL CONSTRUCTlON ,Y�tp�� <br /> �1n <br /> [�ELEGTFttCAR. (S� � AMP SERViCE Q PROGRESS �NERGY �J W.R.E.C. <br /> L ���� �P�� � <br /> [�PLUMBING $ t �S <br /> �j�� ���� <br /> QMECHANICAL $ VALUA710N OF MECHAfdIGAL lNSTAUATlOFV � <br /> C��" �-��t�`�r� <br /> [�GAS C] F200FING [� SPECIALTY � OTHER y�✓��� <br /> =1NiSH�D FLOOFt ELEVATIONS PLOOD ZC1NE AREA QYES NO � _ <br /> 3U1lQER � "� COMPANY . <br /> 3tGNATURE � REGISTERED Y id FEE CURRE� Y/N. � <br /> - -- -- ---.�_ ___�—_ -_____._____ _ _ � _._- ____._ T_ -'`-'-�-----�— ------ <br /> Address License# � I <br /> °_I.ECTRICIAN COMPANY <br /> 31GNATUI'�E RECsIS'TERED Y I RI FEE CURREf� Y/N <br /> Addreas License# � , � <br /> �I.UM6ER � COMPANY <br /> 31GRfA'RlRE �tEG�s'�ReD Y/ N FEE CURRER Y/Rt I <br /> Aeldress Ltaense# <br /> IIECHAHICAL COMPANY <br /> zIGNATUFtE FtEOISTERED Y! N FEE CURREt� Y t M � <br /> Address � License# �—i � <br /> )THER COMPANY <br /> EIGNATURE " REGIS7EREq • Y/ N FEE GURRE� Y(N <br /> Address �icense# ! � <br /> tEStDENTtA! Attach{2),Plot Pians;{2)sets,of Buitding Pians;(1 j set of Energy Forms;R-�-W Permit far new construcNon, <br /> Minfimum ten(10)_working days after submittal date.,Ftequlred ansite,ConstrucUan Pians,Stonnwater Ptans w/Silt Fence InstaAed, <br /> San{tary Facilities&1 dumpster;Slte Wbrk Pertnit ior subdivlslansAarge projeats <br /> :OMMERCtAt Attach(3)cornptete sets of Buitd(ng Pians plus a Life Safety Page;(1j se#of Energy Forms.R-O-W Pertnit for new constructlon. <br /> Minlmum ten(i0)working days after submtttal da#e. Required onsite,Conshuctlon Plans,StoRnwater Plans w/SIIC Fenae installed, __ <br /> Sanitary Facilities&1 dumpster.Site Work Permt#for all new p�ojects.A�i commerclai requlrements must meet compllance <br /> �iGIV FERMIT Attach(2)sets of Engtneered Pians. <br /> '*"PROPERTY SURVEY required for ait NEtN construction. <br /> �irecNons: , <br /> FNi aut application compietely. " ° <il�`{ ,�-'�-� - .. , , J <br /> Ovmer 8�Contractar sign back of appltcaflon,notarized <br /> if over�250p,a Notice of Commencement is required. (AlC upgrades over 57500) ' ', - <br /> � � �i <br /> Agent(for the oontraotar)or Power of Attomey{for the awner)would be somenne wlth nota�lzed#etter from owrser authorizing`satne � , ,.,. <br /> ►YER 7HE Ct1t1NTER PERM1TTtNG (Front of Applicatlon Onty) � - ' �' <br /> ;eroofs if shingles Sewers Servlce Upgrades A/C Fences(PIoUSurvey/Faotagea , <br /> Driveweys-Not over Caunter if on public roadways..needs ROW � ., ; � � '� ' ," '; " _ ,, , � � y <br /> � � - . � -¢ ` - " . <br /> , � - , - <br /> , _ ..� .. ......� ..�. .< . ,:;,:�..,. . _ <br />