|
v„-,o,,.�,,.�� t,;�ty ot Gepny�hills Permit AppAcatian Fax-813-780-0021
<br /> BuHding Qepartment'
<br /> .te Recalved = Phone Contact for Permittin i � � ��� — '�`� `
<br /> rner's Name ��v Z �' Owner Phone Number � � ✓ ✓ /� - ��J
<br /> rner's Address ...+ � �.� d R. �T Owner Phone Numbsr
<br /> e Slmple Titleholder Nama Owner Phone Number
<br /> I
<br /> I �Stmple Tltleholder Address �
<br /> �
<br /> �B ADDRESS � / �`�'"�C ✓ �i �`7 G7 D 12- J�"�Th� I LOT# �
<br /> �
<br /> iBDiVISiON PARCEL tD# ( � �
<br /> (88TAINED Ft28M PRdPERTY TAX NOTtGE)
<br /> SRK PROP05ED � NEW CONSTR� ADD/ALT � SIGN Q Q DEMOLISH
<br /> INSTAIL REPAIR
<br /> ;OP05ED USE � SFR Q COMM � OTHEF2 �
<br /> PE OF CONSTRUGTION Q BLOCK Q FRAME � S7EEL Q
<br /> ;3CRtPTiON OF WORK ��� � �� -� 1 t� � � � � e °"� �1J'�71 L�/1�
<br /> , I�LDlNG SIZE �,_,_„_� SQ FOOTAGE� , � HEt�aNT C�,�
<br /> QBUILDING �� VA�UATION OF Tt�TAi.Ct}NSTRUCTIQN
<br /> QELECTRiCAL (;s� AMP SERVICE [� PROGRESS ENERGY Q W.R.E.C.
<br /> , t
<br /> �'i QPLUMBING (S6__�
<br /> L
<br /> II QMEGHANICAI $ VA�tlATi4(V OF MECHANICAL INSTAl.CATION
<br /> � ������
<br /> QGAS Q ROQFING Q SPECIALTY � � OTNER
<br /> ' IISHED FLOOR ELEVATIONS ��� FLOOD ZONE AREA QYES N4
<br /> �
<br /> � �
<br /> ILDER COMPANY
<br /> '� iNAT'tJRE REGIS7ERED Y/ N FEE CURREA Y!N
<br /> �I Address (.fcense# � �
<br /> I `cCTRiCtAN COMPANY I
<br /> tFiATURE REGISTERED Y/ N FEE CURREA Y/N
<br /> Addrass Llcense# � �
<br /> �
<br /> )�ABER COMPANIf I
<br /> � �NATtTRB REGISTERED � Y! N FEE CURRE� Y/N
<br /> Address i L.icense# � �'�
<br /> CHANIGA! � '-- ,�f � COMPAtdY l�/�'�I�J`� �-'�'S*".��'
<br /> NATURE G��iJ� L�/' .U�"� REGISTERED Y J N FEE C RREP Y/N
<br /> Address � Llcense# (,� �C� �� 'p
<br /> , � ____1���
<br /> �ER � CQMPANY .
<br /> NATURE REGISTERED Y/ (d FEE CURREh Y 1 id
<br /> ` /4ddress License# ( ` �
<br /> iIDENTIAL Attach(2)Ptot Ptans;(2)sets of Building Plans;(1)set of Energy Fort�ns;R-O-W Permit for new canstruc8on,
<br /> Minimum ten(10)working days after submittal date. Required onsite,�Conshuc8on Plans,Storsttwater Plans w/Sf1t Fence Instafied,
<br /> Sanitary Facill8es&1 dumpster;Site Work Pertnit for subdlvislonsflarge proJects
<br /> MMERCiAL Attach(3)complete seks of Butlding Plans plus a Ltfe Safety Page;(1}set of Energy FoRns.R-O-W Perr�Et(or new c�nst�uction.-
<br /> Minimum ten(10)working days after submlBal date. Requfred onsite,Co»strucHon Plarss,Storsnwater Ptans w!Sitt Pence finstailed,
<br /> Sanitary Facllttiss&1 dumpster.Slte Work Permit for all new prcifects.All commercial requirements must meet compiiance
<br /> N PERMIT Attach{2)sets of Engineered Plans. '
<br /> ""PROPERIY SURVEY requlred for a!I NEW canstnict�on. �
<br /> ctions: _ �
<br /> FIII out appAcaHon campletely. , �;_ , -
<br /> Ow�er 8�Contra�tor sign back of applicatfon,natadzed ' '.
<br /> If over$254Q,a Noflce of Gortemenc:sment is required.� jAiC upgrades,av,ec$750d) ; � ' `; :�''� r
<br /> Agent(for the contractor)or Power of Attomey(for the own�rj�would be someone with notarized lek#er from owner authorizi'ng same • •-- `�
<br /> :R THE CQUtdTER PERMITTING (Front of ApplfcaUon Qnly) , �
<br /> �ofs if shingles Sewers Service Upgrades R!G Fences{PloUSuroeyiFoatage) ,_. ,. ._ _.. -- �°. �_ - ` '�'�
<br /> � ,.,: . r �,
<br /> Drlveways-Not aver Counter!f on publlc roadways..nesds,RQW u.. � ?i'-.'• •' - "� � � _
<br /> � ,. . ... .. ' �5� '-� .':1�.... .`x
<br /> . .. - �. ;i�_; � .. .- ..__ . , . �: :1 " � �.; _���� „,tti'i�. :.
<br /> � { �c� , �<:'I:.„� ,. '�i ,;' , .,_ , ; . : ", -- `' � _:.�-.-�.e.,'.
<br /> n� � ,.,...�,�i'� • ' � . .r ,�o-^�'z.:: .-�
<br /> ., ., �., � ' .. .,`... ........... .... i " ... �a:
<br /> �
<br />
|