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e�a-780-0020 Ci#y of Zephyrhilis F"ermit Appl' Fax-813asaooz�
<br /> � Building Depertrnen ,
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<br /> Da�e Rec�ived :.�'j�.�. -� ' Fho 'Corita ?for:�Parmi ��` � s - .
<br /> Owner's Name a • � . Owner.Phone Numb�r` — �1 �
<br /> ; Owner's Address °.. Ginrner-Phone Mainber ' ��!���''�f li �
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<br /> , Fee Slmple TiHehold'er;Nam� � � � • , Owner Phone Number" �� , � ._��,� .
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<br /> Fe�$imple�Tltlehalder Address - " - � "
<br />�' JOB ADDRESS / � , E' ' , . , , ` LQT# �,��, ,
<br /> SUBDIVISION �L'o�,,�;��, ('��c�� PARCEL ID#' ��""'��G:�a=1--Ql�FC� =G4pocs=c�jG,�'O . .
<br /> , , . " : - . ' "_�(08TAlNED`FRQMPROP.ERTYTAXNOTtCE}
<br /> Wf3RK PRGIP..OSED �' NEW CONSTR �" ��`� ADD/Ai;T � � SIGN °�[� ' =.�„ .DEMO,L`ISH - ,,„
<br /> - : � ,..� ��.�INSTALL 8:-r. '.REFAIR' ` � • �
<br /> PROPQSEQ:.USE-.. � '. : Q.� SPR' '� `�] COMNt" '�� 'OTNER `..
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<br /> TYPE OF CONSTRUCTION._.��� : .°;BLOCK;' ' r0'; FRAME, L� . ,,STEEC .�]: '.� , : . �
<br /> DEBCRIPTIOW OF WORK� �,` -i f '", � � ` � � - �
<br />� BUILDti�G SIZE`�'� � SQ.FQQTAG�� 4�C�JO , , . >. HEIt3N7'� � ff���'f..� .
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<br /> ��. BUIlDIt�IG � ��;c:..;a.y . ._�;��.. - , � .
<br /> , � VAklJAT10N`�OF'`TCI'TAL�CfJNSl`RkICTION ,
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<br /> ' QEI.ECTRICAL $� � AtU1P SERViCE ��[�` PROGRESS ENERGY �[�. W.R.E.C.
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<br /> QPt:UMBING .�� � � �� ` l./
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<br /> OMECHANl� $ . �V1tt.tli4i'ION:4F MECHA4VlCA�ENBT'A�LATION - .
<br /> �: . ... . . - ��i
<br /> �GAS ;.. - ['�,,,�, ,. . - ROOFING..;:Q SP.ECIA�TY Q - OTFlER �° � � Ll` ��
<br /> FIfVI E � ��
<br /> 5H D Fl.00R ELEVATIONS FLOOCI ZONE AREA , QY . NO �f�
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<br /> BUti.OER g� �C���'1 {—,, O�� COMP 4 � W�1 Y�i tin �(� P'Y�.. ' -
<br /> SiGtdATUR� f �" � � 5 " � E ,
<br /> 6 REGISTERED Y/ FEE rtt�n Y/N, �. , , ,
<br /> Addreas ` ' . � Li�# SC-["`*)5115�C�G� I
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<br /> �• ELEC�RtCU4N»„ . �, ° COMPANY ' , . , , _ � - _ .
<br /> ' SIGNATURE r y REOISTERED Y/ N FEE CURRE� ' '.Y/N _
<br /> iAddre�s - -, ., - < ' 4, , �t ., . :License'.#:u� *- �
<br /> PLUMBER ` ' , . COMP.ANY� - -
<br /> SIGNATURE " � � F'�- . �
<br /> r>�,- , REGIBTEREp' , �:Y'/.:N;, :.FEE,CURREk'° ` "`Y/-N;.
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<br /> � /�ddress - '.�. - . . . - _ . ,- . ._..LlcenSe#,,.�� _ . I .
<br /> MECEIIWIG/t!:"y` . ... .. , Y� ,F _ . :GOMPI4NY; . s•,t�.,: .�:4fi: - _ _ _' � . ` '
<br /> SIGN�iTURE RE�+ISTERED,: �Y(-N- �:�CUwte�� . :Y/N
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<br /> �ddress; , °�: . ,; :�:� -. _.,. ,., • :�. , ,. . ` ' � , , ', ,._Islr�nse# _.( ;, �_ ` _ �
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<br /> � OTMER � ' _, ., ,.C,Oti,�PANY , --.`. -
<br /> � SIGNAYURE.. . ^... , . ' .`_,: .`'' �,REQIS7ERED_ ':Y/ N�: ;' .;EE�:GURREk, ;Y.:/;f�l,:,: �
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<br /> %�: :i _ - � `�:� ::�� '7"" vF%.^�.i^.':`kl.}�fy:!::".:Ty*�".�t.aa�.. _, .. ,
<br /> EtESIDEN'i1Al.,. �Attao#i'2:sP1ot;Plaits�:2��sets�of�Bi�ldt`=;+i?Ians.�1�set�of,�EneY �Forriiis'"Ft-t�W'Permlt,far:nevy:cans.qvction,; .,
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<br /> �Miniinum�,ten°(1:0);worktng;days�aiterk"sub.;i�iiHsl�clate:=�Required a`nslte;�t�onsiriicaon�Plans�;,Stoimwater_plans.w%Sllt Fen.c,e,instialled,.; . ,
<br /> . .`;�:`•.Santtary Fadllti�es,8�1,dumpster;S{tekWorkYPerinit�.fo�r,:sutidlvisiorisAatge projec2s 3�<��._. : `�:� ': � ,_ : � �, �: '_ ` .. -
<br /> ', C011tiltl�Et2Cb� AEtac�s(3)c:omple#e�set5 cf Stiil+ilrig"Plans p�lus a life Safety P�ge;{1}set af Eiiergy Forms.R-O W Permit for new caastnictian.
<br /> M1Nmum ten(10)working days'after submiHal date. Required,onslte,.ConstrucNon Plans,Stormwater Plans w!Sllt Fence installed; ,
<br /> � Sanftary,Fadtities.&_1:_¢umpster.,.Site_Work_Permltfor,allti�ew�project's:AUcommerdal:cequtremenis-mu�tmeet.compitance , _
<br /> � :SIC3N'PERMiT Atts�tf(2)sets of Eng1,�+�ered:�!1��3 t�,��s�s� - � � ' � �� . .
<br /> � """"PROR'�RTY SURVEY��Qqulr�d for all(VEIN c;onstructlon � • - x -' , � . - -
<br /> �° ,Dtrei:tions: . -.�<,^.:. . .. ,_- , __._ . _..�._ n. _� ,.� _ ._ .
<br /> ��ill•out applicaSfar�completely.
<br /> , Quvner&Gontractoc sign.bacic of app[ic:a�on,natarized I
<br /> � If over 52500,s��Notice:of Commencq,ment ls requlr+ad._ (AIG.upgrades oyer�75Q0),., _ f t . � . I
<br /> ->r.y:•;�;,�-:;�,.�,;:;.:.� ,. :.:. .., .�..�:.,,._. . ..,...,_ p..._�-. _ �. .
<br /> " Agent=(farttie'contractorj o7:Power'of Attoiney(fo�'#he'owner.)would be someane:with notarized letter finm owner suthorizfng same
<br /> ' 'DVER=THE-COUNTER:PERMtTI1NG:-:«.:`(Front;af�l�ppltcaSbn Only).��� ':;`::.. :`�--�-"� - �
<br /> � Reraofsifshingles Sewers Senilce'Upgrades��A/C,: ._,Fences,(Plot/Surv_ey_/Foatage) . ,.- � --
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<br /> priveways-Not aver Counter If on•public roadways.:needs ROW ��`'���J
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