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813-T84-0424 Citjf Of Z@�?�t}/C'�'itIIS PeCfT11t A�}�ItC�tIQCt Fax-813-784-0021 <br /> Buflding Department <br /> Date Racelved . _ � °Fhone Contact#ar Permittln �_ <br /> Owne�'s Name Ownar Pho�e Number <br /> Owner's Address ' - Owner Phone Number '�— � <br /> Fee Slt�sple Tlttehctder Name � � Qwner Phone Namber � � <br /> i,°r .�.� <br /> / <br /> Fee Simpie Titieholdsr Addr.e�s " <br /> JOB ApDRESS ��✓ �-� �QT� � <br /> SUBD1VI510N �D_-y_f f'`�4�-�' I PARCELID# ��� o�. ���0 Cy��CJ �` I 4� <br /> (OB7AINED FROM PRQPERTYT1lX NOTICE) , <br /> WORK PR4Pt�SED '•NEW CONSfR' �.'� � ADD/ALT � ' S1GN' CJ Q QEMOI,ISH <br /> e� }NS'FALi. H REPAIR - <br /> PRQPQSED-USE Q SFR � COMM'� � OTHER <br /> TYPE QF CONSTt2UCTiON-". �Q BLOGK ~ Q FF2AME [� STEEi. Q <br /> DESCRIP'170P1 OF WORK 1�'��J�- ��� ��-Q� <br /> BUILDING S1ZE ��� � SQ.F007'AGE[_�. HEIGH7. ��,_� <br /> QBUlLDING $ � --�r=-=,.�._ ..� <br /> �,_� VALUATI�N.OF'�OTAL CONSTRUCTION <br /> C]ELECTRICAI � � AMP SERtIICE 'Q PROGRESBfNERGY Q W.R.E.C. <br /> QPLUMBlNG � 1,—^`� , <br /> QMECHANICAL $ VALUATlOtV qF MEGNANICAL lPtSTALLATit?N <br /> . -���: <br /> [�GAS Q ROOFING -;Q SPECIAl.TY-Q. � OTNER � <br /> FINlSHED FLOQR ELEVATIC?NS C�'�-� FLOOQ ZONE AREA QYE3 NO" - <br /> �._._.�:�...���,� ��� . <br /> BUt�DER ,�.��.�.=-�_..�__.�.. COMPANY �� ��-�. <br /> SlGNATUR =-^",..�-------"'` �cE��STE�z6o• Y i N ��cuR+�Er� Y l N. <br /> c_,_�.----- <br /> Addre�s ' L;icense# � ��� <br /> El.ECTRiClAN.. .� - COMPANY '- � - � <br /> SIGMATURE �' REGlSTEREd Y I N FEE CURRER Y l N <br /> Addre�� � License# l�- � � <br /> PI.UMSER , COMPANY � <br /> SlGNA7URE � � ,R�GtSTEREO . X/ IV. � FEE CURRE� Y 1(V � <br /> Address License# ���� ^� <br /> MECHANtCAI � ' COMPANY . <br /> '�SIGNATURE � � x.'s�Gisr�Q . Y.L.N _ F�E Gu�n Y J N-.: <br /> Addra�s� ` �Lfcense# �� �� <br /> O'fHER � � COtU1PA1dY <br /> SIGNATURE� � ' -- , �R�cisTE� Y!'N .� . F�eu�n Y i N <br /> Addrsss - � � ' ' Ucense# I� � <br /> �EtEStDENT1AL, ,a iAttach(2);PtoC,;Pians;:.(2):seEs=of:Biilidliig°F!lans;`{'!)set o#Eriergy Fomis;��R=G1-W Peitrilf for ne6ir caristivattan, -�: . <br /> _- Minimum;ten;(1,0)�working;days;aitec.subrrilttal`date:�Requlreil.onslte;�ConstruoNon Plans;3tortiiwater'Plans�rr!S(!t Fence fnstalted, <br /> � Sanitary�Factllti,es<&�t3dumpster.Slte;V1►ork:Permitfor'subdlVislons/large proJects ��'-��` ' ' • ` = <br /> COMMERCtAt. Attach{3}'c�inplete sets'of Bu1ldfiig�Plans plus a L`Ife'Safety Page;(1)se#af Enetgy Forms.R-O-W Pertnit far new constructtan. <br /> Mintmum ten{10)workMg days after submitta!date. Required onslte,ConstrucUon Ptans,Stormwater Plans w!Sllt Fent�lnstaNed, <br /> Sanitary Facili8es&1 dumpster.Site Work Permlt for all new,'projecfs:-All commercial requlrements must meet campliance <br /> SIGN PERMIT Attacti(2)se#s ofErigineeied�,P„tans.;�.;>���. ' {: , : , ` � <br /> ""'PROPERTY SURVEY r+equlred for.aN.N,EW_cansWctlan. <br /> 4iI�Y���nsi . �a f <br /> FlII out applicatton c;ompletely. " - <br /> Owner 8 ContracMr sign back of applicatlon,notarized _ ' <br /> tf aver 52500,a Notice•of Commencement'ts required."rA/'C Cipgr�d'es.p�(�r S7S00) , _ <br /> !t '..,.�.��.�.��.� ,'��S.:f,.��.. '�: ' . ' : <br /> P�qent(for the confracto�)�ar`Pauve`r of"AtFomey`(for the orvne�j would.be someorie wi#fi notarized letter from awner authorizing same <br /> G3VER THE COUN'i'ER=.PERMITIING r.--••(F-,ront•of,Appttcatlan�Onty} ' , � 4 ` <br /> Reraafs if shingies Sewers Sen±ice Etpgrades AtC Fences{PtatlSurveylFoatage} <br /> Driveways-Not over Counter if on pubtic.roadways.needs ROW �' �. <br />