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o,,.,o„-,,,,�„ t;ity ot[ephymiiis Permit Appiicatian <br /> Fax-813-78Q-0421 <br /> Buttding Department <br /> te Recelved = Phone Contact fcr Permittin " <br /> » N� (�„ c�,GT7,c/ bwner Phone Number �(�� �( } ` �` S <br /> rner's Name <br /> �ner's Address � � � ' �-� f°`' Ovvner Phone Number , <br /> a Simpfe Titlehaider Flame Qwner Phone Number � <br /> �Stmpte Titleholder Address � <br /> LQT# <br /> 8 QC?DRESS � <br /> 'BDIVISION �` � PARCEL Id# <br /> (08TAINED PRdM PROPERTY TAX NQ'TiGE) <br /> yRiC PROPOSED e NEW CONSTR 8 ADD/Al7 � 5lG�f Q Q DEMOtCSH <br /> tNSTALL REPAIR <br /> .OPOSED USE Q SFR [� COMM � O7HER <br /> PE 8P CONSTRi3CTiON [� BIOCK Q FRAME [�� S7EEL Q <br /> SCRIPTION OP WORK �� l`� ` - C �� <br /> �iLdiNG StZE [�____� SCt FOOTAGE�___� HEIGHT ��_� <br /> QBUILOING � � VALUATION OF TOTAL CONSTRUCTION <br /> QELECTRICAL ($— � AMP SERVICE Q PROGRESS ENERGY CJ W.R.E.� <br /> � ��QPLUMBING $ �f � <br /> C]MECHRNICAI $��� VALUATiON OF MECHANiCAL ItVSTALLATIt�M1! <br /> �� �1 <br /> [�GAS Q RQQFfNG C) SPEClAI'fY [� OfiHER <br /> lISHED FLOQR EIEVATiONS ��� FLOOD ZONE AREA �]YES NO <br /> I1.DER COMPANY <br /> iNATURE REGiSTERED Y/ N FEE CURRE� Y 1 N <br /> Address License# � �� <br /> ?CTRiC1AN COMPANY <br /> ;NATIlRE REGiSTERED Y! N FEE CURRE� Y/N <br /> Address Lice�se#'�— �`� ! <br /> JMBER � � COMPANY <br /> �NATURE REGI$S�RED Y f N FEE CURRE� Y i h! <br /> IAddress �icense# �� � <br /> r <br /> CHANICAL COMPANY r�� �"N ''� <br /> � NAi'URE REOlSTERE4 Y/ N FEE GtJRREt� Y/N <br /> I � — <br /> Address license# C / C>�.. � � <br /> iER � � COMPANY <br /> NATURE REGISTERED Y/ N FEE CURREI� Y/{�! <br /> Address Liaense# �� � <br /> iIDENTiAL Attach(2)Piot Plans;(2}sets of Butiding Ptans;(1)set of Energy Forms;R O-W Permft for�ew constructlan, <br /> MlNmum ten(10)working days after submlttal date. Requfred onsfte,Constivction Rlans,Stormwater Plans wi Silt Fence Installed, <br /> Sanitary Facilities&1 dumpster;Site Work Permit ior subdlvistonsilarge pro]ects ' <br /> AMBRCiAL At#ach(3}comptete sets of Building Plans plus a Llfe Safely Page;(1)set of Energy Forms.R-O-W Permit for new construction. <br /> Mtnimum ten{10)work{ng days after submtttai date. Required nnstte,Construction Ptans,Stormwater Plans wl Silt Fence lnstalled, <br /> Sanitary Factitties&1 dumpster.5ite Work Permit for alI new proJects.All commercia!re+quirements must meet compifance <br /> N PERMIT Attach(2)sets af Enginee�ed Plans. " � <br /> ""PROPERTY SURVEY required for aii NEW Construo�on. <br /> cttons: <br /> Fill out application completely. <br /> Owner 8 Contractor stgn back of app(icatton,notarized <br /> If over�2500,a Notics of Commencament fs requtred, (AIC upgradss over$�508} <br /> Agent(for the contractor)or Power of Attomey{for the owner)wauld be sameane with notarized letter from owner authorizing same <br /> °R THE COUNTER PERMlTTING {Front bf AppNca@ori`Only}'," �`;.�'-`;���"i, <br /> �ofs!f shingles Sewers Servtce Upgrailes-AIC�"�`'-�Fences(F!IotlSurveylFootage) <br /> �;;,,y•>+:�, , : � � <br /> Drlveways-Not over Counter if on pub!!c roadways..needs ROW' � �' ' - � <br />