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_._ .__ ____ ti,,�ry or Lepnymi�is rermtt Apptica#ian Fax 813-780-0021
<br /> 8ulld(ng Department
<br /> Date Received �jv f ' /,� phone Contact for Permtttin f� � - �����
<br />� Dwner's Name u-�/-�en-�/�-*� � ��� � � tlwner Phone{�umber ./,�• !'7,3.5"Z c5�`
<br /> Dwne�'s Address cs �..�.//�C�-� s--'� Owner Phon�Mumber
<br /> F�e Simpie Tltieholder.Neme � � Ov+mer Phone Number ��� �
<br /> Fee Simple Tttlehalder Address
<br /> �I..S� � ��� '"" '7'?�"' K /�LC1T# �•--
<br /> 30B ADDRESB ,7 �-, .-�►
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<br /> sueQnr�siaN �,�/�v�( G-�rr�s-� PA�c���� l.S';�2 6;,� � e�- �s - �e�c�� --G d�
<br /> (OBtAINED�FROM PROPERTY TAX NOTIGE)
<br /> WORK PROPOSED NEW CONSTR ApD/ALT � SIGN Q [� DEMOLISH
<br /> tNSTAtI 8 REPAIR �
<br /> PRt)PLISED USE Q.�SF.R CJ COMM [� OTHER
<br /> TYPE OF CONSTRUC710N BLOCK Q FRAME C� STEEL Q
<br /> D�����t�����w�,�K c- � � r�,� ��c�__ �
<br /> BUILDING SlZE �� K // �_� sG!FOOTAGE�_�� HE#GHT ��,_„�
<br /> QBUILDING �9S ..�t�,�� ,�.� VALUA710N OF TQTAL CONSTFtUC710N
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<br /> QELECTRtCAL $ T�,,� AMP SERVICE � PROGRESS EMERGY CJJ �U,R.E.C,
<br /> � i���
<br /> QPLUMBING $ � �'✓�
<br /> ����� �
<br /> OMECNANtCA! $ VAl,UATION OF MECHANICAL INSTAL4ATION . � ��
<br /> 3 � �,�� �-���s
<br /> [���as (p Roa��r�� p sp�c�a�.nr Q OTiiER t�' � �.���R.Q.+'v�.�
<br /> =1NtSFSED FCOOR ELEVATIONS FLOO�ZONE AREA QYES O
<br /> 3UILDER' �f�'��* "��g�' COMPANY �i"R �C �c�S /`�e.i e-�es n1
<br /> 3tGNATttQ2E !t� (,,,.t�l;�J�i�"'�'�� REGISTERED Y J (V FEE CURRE� Y/N
<br /> Add�es5 Ucense# �� ���
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<br /> eLECTR1CtAN i�/e�y'��� ' COMPANY � • � �t,,, W �
<br /> a1G�lATU#2E . ,,_,,r,_,__.�_' REGIS'fERED Y/ N FEE CURRE� Y N
<br /> Address .�.f �d�%'S� �""", License# �?� ��
<br /> �LUMIBER y ,,_ 4 �' COMPANY Y � '�'"�.
<br /> 31GildATUF�E _��`�� e n,�r�h'�1r✓� REGlSTERED Y/ N FEE CURRE�
<br /> Address i��Z Ucense# ��`�,����� �
<br /> n�c�a�iaa�. ��- coMPAMt d4 `s � er,. �� ,y �
<br /> i1GMATURE REGl8TERED Y/ PS EE CURRER Y!N
<br /> Address Ucense# ��U�f 7 g�-�'��
<br /> ?THE�i GOMPANY .
<br /> �ICaNATURE ,,,_,, R�cis��eQ Y! N fe�cuaR�a Y/N
<br /> Address Ltcense# � �
<br /> lE51Dl�N'CIAI. Atkach(2).Plot P4ans;{2)sets af Building Flans,{1)set of Energy.Forms;R-4-W Permit for new construction,
<br /> Mlnimum ten(10).working days after submitkal.date. Requlred onsite,Cansbuctlon Plans,Stormwater Plans w/S(It Fence instaHed,
<br /> Sanitary facttities&1 dvmpster;8ite Work Permik for subdtvl'slonsAarge pro)ects
<br /> ;OMMER�faL Attach(3}comptete sets�'of Bufiding Ptans pius•a i:tfe Safety Page;{1)set of Energy Forms.R-Q-W Permit for new construction.
<br /> Minimum ten(10)working days after submlttal dake. Required onslte,Constnac8an Plans,Stormwater Plans w/S#Ii Fence Installed,
<br /> Sanitary Fadlities&1 dumpster.51te Work Pertnit for atl new projects.All commercial requirements must meet compllance
<br /> sIGN PERMtr Attact�(2)sets of Engineer,ed Plans. � � . "- - ,
<br /> "`"PROPERTY SURVEY requlred tor all NEW conshuctlon: � �
<br /> ►Irectlor�s:
<br /> Fill out applicadon completely.
<br /> Owner&Conhactor sign back oF appllcatton,notarized
<br /> !f over�,ZSO4,a i�otice of Commencemerrt is requtred. (AtG apgrades over�7500) °
<br /> ' Ager�t{for the contractorj or Power af Attomey(for the oumerj wautd be someone with notaNzed letter trom owner authofizing same
<br /> }VER THE G�/ttNTER PE�MI7TING ,{Froni af AppticaUon i?ntyy r . - -. - - ' ' � - ,
<br /> ;eroots(f sh(ngles Sewers Servl,ce Upgiades`A/C , , _Fences(PIaUSunreylFootagej ' � , �-
<br /> ' Driveways-Nat over Counter if an,pubtic roadways:.needs ROVN
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