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_._ ._ �____ wtiy or c.epnym«�s r�erm4t Application Fax-813-780-0021 � <br /> � 8uliding Department <br /> I <br /> I . <br /> Uate tteceived . ° Phone Contact fcr Permlttln <br /> I Owner's Name I �~ .,- r �S% �.=.�Owner Phone�tumber 3.� t�'� i.S��Jd , <br /> r^ r'' > ,�� � <br /> pwner's Addres� L' �U.f�~z�-��~'� �"� Owner Phane Idumber <br /> Fee Stmpte Titiehoider Na�me � ` �� OwRet Pt�qne t�utnber r, ,_,_„_�,_.. ; <br /> f � <br /> Fee Slmpia 7ftiehoider Address <br /> JOB ADDRESS % Z- ` C '' � 7� y� ^ ? � Lt7T# � � <br /> ' SUBDNtsiON �vl-J1tist.� f �r��'i.��--� PARCE�ID# �J`"� Z.J •--� --Gc.�o c cJ -�C9� QCT , <br /> (OBTAINED FROM PROPERTY 7AX NOTICE) <br /> ' WORK PROPO�EQ �NEW CONSTR 8 aQo�a�.�r � SICiR! Q Q DEMOLtSH i <br /> INSTALL REPAIR <br /> PROPOSED US i [� SFR Q COMM � OTHER <br /> fYPE OF CdNSTRUCT{ON �Bl.QCK Q FRAME [�„� S7'EEL Q I <br /> } .�.� <br /> DESCRIPTION OF WORK /oc.'-� .b��" <br /> BUfLDING SIZEf ��l��f� � SQ FCl07AC,E� tiEtGHT �__� � <br /> I � <br /> QBUILD,ING $ �„�,�..�� VALUA7tON OF fiOTAI.GONBTRUCTIO�t <br /> i , <br /> I QELEC� RICAL $ s,� AMP SERVICE Q PROGRESS ENERGY [� W.R.E.C. <br /> I [�PLUM ING {9�� <br /> �_ <br /> [�MECNANICAE $ VALUA7tC1N OF MECHANtCAL 11VSTALU4710N <br /> �'� i <br /> i �]GAS Q ftQOFiNG [� SPECtALTY [� OTNER <br /> °INISHED F40 R ELEVATlONS FLOOD ZONE AREA [�YES NO <br /> � �_..� <br /> 3UILDER � p �— �'—.. COMPANY <br /> SIGNATURE � `/� ��sJ l �fi-j G w REGlS7ERED Y/ t� PEE CURRER Y f N <br /> Addrasss License# ��� i � <br /> :�EGTRICIAN ' ��� COMPANY ���R I] �f�!��'� L-- , <br /> �1GtdATURE �'� REGISTERED Y! N FEE CURREl� Y!N <br /> Address ,3 L � � Q r-t+i ��S License# G���. �� ; <br /> a�.UMBEit { �Q ) 7Q��—+ COMPANY N��S �.-� �^-} ji �`� �� � <br /> il.t',HATURE V"'���"' REOISTERED Y/ N FEE cU�REt� Y!N <br /> `` / 3 �5Y Z <br /> Address �f i�� � � "� �'L' G�l l.3 Ucense# C f-C--,��(�. S�-�7L � , <br /> AEGHAI+lICAI. ,� /��� COMPANY ����.S �i� .9�*'L G A� Q ,�{I/r�.. I <br /> itCsNATUEtE ��" ��"' REt,i1STEREQ Y/ N FEE CURRE� Y/N <br /> iiddress �YY/ /d�`l^� i� -f�jf.s 3.�.5'�f �ACo Y�`l��i ._..� s <br /> Ucense# <br /> � , <br /> )THER I COMPANY <br /> i1GNATURE ! REGlSTERED Y! N FEE CURREM1 Y/N � <br /> I <br /> 1 <br /> Address i Ucense# � <br /> �� <br /> tES10ENT1AL ' Attach(2?.Piot Plans;(2)sets of Building Plans;(1)sek of Energy-Fotms;R-O-W Petznit fpr new construation, <br /> Mlnimum ten(10)working days after Submlttal.date. Requlred ansite,ConsUuctton Ptans,Stormwater Pians w!Sitt Fence instalied, <br /> � , Santtary FaclABes&1 dumpster,SRe Wdrk Permlt ioc-subdfvlstonsf#arge pro)ects <br /> :OMMERCIAL � Attach(3)complete sets of Building Plans plus•a l:ife Safety Page;(1)set af Energy Forms.R O-W Pertnit tar new construcNon. <br /> Mtnimum ten(10)working days after submittal date. Required onsite,Consbvctfan Ptans,Stormwa#er Ptans w!Siit Fence installed, <br /> � Sanitary FacfARies&1 dumpster.Site Wotk Permlt for al!new proJects.Aii commerclat requirements must meet comptiance <br /> �IGN PERMIT Attach(2)sets of Engineered Plans. <br /> � '"""PROPERTY SURVEY requlred for a!!NEW consUvction. <br /> ►Irectlons: <br /> FUI out application completely. <br /> Qwner&Contractar slgn back of applicatlon,notarized <br /> If aver�2SQ0,a Notice of Commencement Is rgquired. (AtG tapgrades over 57500) <br /> ' AgeM{for tt;e contractor)or Power of Attomey(for the owner)wauld be someone wlth notarized letter from owner authodz[ng same <br /> IVER THE COUWTER PERMl7i'!NG {Front of AppllcaUon Only) <br /> teroais if shinglis Sewers � ...`Seritice Upgrades A/G�:.. ,-�encas(Plot/SurveyiFootage) <br /> Drlveways-�tot aver Connter if an pUbiic roadways,.needs ROW� <br /> 1 " „ •- .. _. _ < . , <br /> i <br /> i <br /> I <br /> a <br /> � . , , <br /> , f t <br />