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es�s-rau-un�u C;It}t Ot LE:�h}ttfilllS P�R111t,A�R11C8fIQ11 Fax-813-780-0421 <br /> Building Department <br /> Date Received r �, � � <br /> � Y ` F'hone Contacttor Permittin �3 Z � � - ��" <br /> OwneNs Na e 1»fN�A S �2(,J�N�ll� Owrner Phone Rlumber �������' 'Y'S <br /> �vner's dldd ess ��`f �/�/� �!�S %� CDt�vvner Phone Rturnber �- � <br /> Fee Simpie ittehotder idame � { Chnrner Phone tdutnber � � <br /> Fee Simpte tiehoider Address <br /> .�oa,���R� s �'�g�t/ �'��K �A,cT�'s 1}rZ �X �ffS l�'/ s3�5'G/Z LOT# ��� <br /> su�o��s�o �� � �ARC�L ID# tr��`L�"'Z!—Dt7�}p�-t�c�D-- t�t O <br /> (OBTAINED FROi4f PROPERTY TAX NOTICE) <br /> Hl106tEC PRtD OSED NEw CONSTR ADD/A�T � SIGIV Q Q QEMOIISH <br /> e ' INSTA�L 8 REPAIR <br /> �RS?POSED U5E Q SFR Q COMM Q OTHER <br /> T1fP�OF C RISTRUCTIOId [� BLOCK Q FRAME � STEEI Q <br /> D�SCFtfPTI 1d OF 1�1"ORK � � � ��. C�� �t <br /> �UIL�ITdG S�E � � St3 Ft?CITAGE�� IiE1GNT �._�� <br /> QB IIDiNG � � VAI.UATION OF TOTAt CONSTF2UCTEON <br /> QE ECTRiCAL � � AMP SERVlCE C] PROGRESS ENERGY C] W.R.E.C. <br /> ) <br /> QP UMBlNG (�> y---y-� <br /> � � <br /> �M CHANICAL $ /J�'J�O� VALUATION OF MECHANICAL INSTALLATION /� ���� <br /> pt � .�� <br /> QG S �]] ROOFING Q SPECIALTY � 07HER <br /> FINISHED F OOR ELEVATIONS � � FLOOD ZONE AREA QYES NO <br /> �U1ILDER GOI�lPATdY <br /> SlGfde4TU6i REGfSTERED Y J N FEE CURRE� Y I h1 <br /> a4ddre s l.icense# �- 1 <br /> �LIECTl21G1 M GOMFARIY <br /> �IGIdG4TUR REGiSTEREO Y I RI FEE CURRE� Y J IV <br /> Alddre s �Icense# � � <br /> ��.UMBER CClMPAIdY <br /> SIGfd�1TUR REGISTERED Y I N FEE CURRE� Y/N , <br /> rAcldre s �t?�r•�� 3t? ��►��-t t�"E �w� L.icense# �,���J v`��t�V � <br /> ��ctta►a� � con��arnr a� � ��it v � !� � �lsS <br /> SIGfd,ATUR REGiSTERED Y FEE CURRE� J N <br /> �lddre s �Ecense# C � <br /> {DT�lER COMPAtdY <br /> SIGR14►tTU REGISTEt2ED Y I N FEE CURREt� Y J N <br /> Addre s License# � � <br /> RESl�EidT Al. Attach(2)Ptot Plans;(2)sets of Building Pians;(1)set of Energy Forms;R-O-W Permit for new construction, ' <br /> Minimum ten(1d}working days after submittal date. Required onsite,Canstruction P1ans,Stocmwater Flans wl Sltt Fence instatied, <br /> Sanitary Facilitfes&1 dumpster,Site Work Permit far subdivisionsAarge projects ` <br /> GOMt�[E!2�IAl. Attach{3}comptete sets of Building Pians-pius a Life Safety Page;{1)set af Energy Forms.R-O-W Permlt for new constnrction. - <br /> � Minimum ten(10}woricing days after submittat date. F2equtred onsite,Consttuctlon P1ans,Stormwater PEans w!Silt Fence instalied, <br /> Sanitary Facilities&1 dumpster.Site Work Permit far all new projecks.All cammerc(al requirements must meet compliance <br /> S1Gh!PER�IT Attach{2}sets of Engineered Pians. <br /> «"•'pROPER'I Y SURVEY requ(red for all NEW construct(on. <br /> Directlons� <br /> Fill o t applicatfon compietely. <br /> Owne &Contractor sign back of application,notarized <br /> if o�se 32500,a Notice of CQmmencement ls required, {AfC upgrades over�7504} <br /> •• Agen (for the contractor)or Power af Attomey(for the owner)would be someone with notarized letter from owner authorizing same <br /> O!!�R'fF�1 GOUtt1TER PERMI7TIMG {Frant of AppNcation Only} <br /> Reroofs if hingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage) <br /> Orive ays-No#over Counter if on publia roadways..needs ROW <br />