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e�a�780-0020 i f Z s P m' i Fax-813-780-0021
<br /> C ty o ephyrhill er it Applicat on
<br /> ; f Buitding Degattment
<br /> Date Recei d �� _ ���
<br /> '� ' Phone Cacitaat`for Parmltttn
<br /> Owner's Na I e �,`�`��� � 7� ��p/,J Owner Phane Number �� �.��• •1!�
<br /> Owner's Addrass �O 1 /// /e �e. Owner•Phana Number
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<br /> Fee Slmple Itleholder Name Owner Phone Number �� I ,
<br /> }_�� .�
<br /> Fee 8lmple Itleholde�Addres� L�
<br /> JOBADDRE�S � � IC...'' IIC� LOT#
<br /> _ �� ,
<br /> susaiv�sro C�¢.�3� Dr�.�t� paRCE�.io# � �S�� �1�D O�a6� ,����
<br /> - (OBTAINED FRQM PROPERTY TAX NOTICE)
<br /> WORK PROPOSED �� NEW CONSI'R ADDlALT � SiGN [� ` � DEMOL;ISH -
<br /> , . � INSTAtL .FtEPAIR
<br /> PROPOSEQ. SE Q SFR -� COMM "� OTHER
<br /> TYPE OF C NSTRUGTION � BLOCK '" �[� FRAME [� STEEI, [�
<br /> .. t
<br /> DESCRiPl1 N OF WORFC A ��S �/� N G''— ' oJ / O�V P�' �,�. I Lf E'
<br /> • �
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<br /> BtlILDIHG S ZE � SQ FOOTAGE . , HEIGHT �� j,
<br /> QB 11..D1NG ($ ,. � -�.;.,;�;.-�__ . �.- _.._..' - . .
<br /> L VALUATION`4F T01`Al CONSTRl1C1'ION
<br /> QE CTRICAL � � AMR SERViCE Q PRCI�RESS ENERGY Q W.R.E.C.
<br /> QP MBlNG $ � t`���
<br /> . _ � � ��
<br /> QM CHANtGAL $ VALUATION C}F MECFtANIGAC 133STALCATION ��
<br /> T�, t�l)� °
<br /> o � o Ro��E�� o �P����.,� o OTHER
<br /> FINISHED F OOR ELEVATIONS r�� FLOOD ZONE AREA C]YES. IVO
<br /> � L
<br /> Bt11LD�R COMPANY
<br /> SIGNA7URH REGI3TERED Y/ N FEE CURREA Y./.N
<br /> Addres' Cicense# t �
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<br /> ELECTRtCI, COMPANY
<br /> SIGNATURE " REGI$TERED Y/ N FEE CURRE� Y/N
<br /> Addre� , _ ,�License#,� I
<br /> PLt1MBER COI�IPAh1Y
<br /> SIGNATURE REGIST.ERED Y/•--N • �FEE CURRE� Y/�N.
<br /> Addre . , License# �� �
<br /> MECHAP#tC1�1. Q 4 a :G{}MPANY . �vl lS �Ne �'�C �-�"d�G'
<br /> SIGNATURE) �� ����� REOISTERED Yr/ N F E CURRE�" Y./�N, �
<br /> Addre�� • '17/'��f,-i'T�1G'� r�; G� �N/L!-�'.�� License# .�'�d����-G) �
<br /> OTHER � • �,COMAIWY
<br /> SIGNA►TUR � REGISTERED Y/ N.;; ' ,Fee eu�n r. Y/:N..
<br /> Addre� . , , ��: , `� .._ � ' _ � ' ticense#
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<br /> _ , �- ,�. ,_ :. .. _ _. .e, >, ,_�.,= ,;:5..,,'.' ., <. ,',,.r., .
<br /> RESIDENTI - Attacti{2},P1at:P,lans;.{2)s+9fs=af�Etisltd[itg Rlaits;(1)set of°Energy=Far�ri§;i2-O=W:Permit:fior:nevir;consfruc6on,.
<br /> - ` - r... .:. ,, :• . �,, .
<br /> - Minimum�.ten�•(:1:0)�working;days;after,'submlEtal'date.:a Requlred onsite,.Canstnicbl'an�Plans;�Stormwate�`Plans w%Sllt Fence lnstalled,
<br /> �_ ,�Sanitary Facilttles::&�1,dumpster,SitetWbik;P,ermttfor:s,utidiyislorisllarge°pcolects` . �;'x'`: `� , .- ,
<br /> s a_.,..,_w..r w. ,.
<br /> COMMERCtA41. Attach{3)`compfete sefs of Buitding P1ans pitts a l:ife Safety Page;{1)set of Energy Forms.R O-W Permit for new constnsction.
<br /> Minimum ten(10)working days�after submittal date. Requlred onsite,Gonstructlon Plans,Stormwater Plans w/Silt Fence installed,
<br /> Sanitary Fadltdes&1 dumpster.S(te Work Permit for all'new:projebts,All commercial requlrements must.mee!compllance
<br /> SIGN PERM T Attactf"{2}set"s of`Engl�eer,ediPla�s;,��::,:,};�.;�. .., �.... ... - .
<br /> ' """PROPERTY SUR1%EY�equired forall IVEW_canstrucUon. �
<br /> Dlrectlons: ; .. , :.�-°� , �
<br /> FIII out ppUcaUon completely. .
<br /> Owner Contractor sign back-of appilcatlon,notarfzed
<br /> if over ?500,a Notice.af.Gommencement is required.. ,(A/G upgrade�over 57500)
<br /> ,��..:,yii-'5;:::I.,., �
<br /> " Agent(�ar th�e contraotor)'or:P"o`wer of Attomey"(for tt�e owner)would be someone with natarized letter ftom owner auttrorizing same
<br /> DVER THE GOUNTER:P,.ERM1TifFtG��-•� -- (Front-of�Application Oniy)�
<br /> Reroofs If sh�ngles Sewers ,Service Upgrades A/C y Fences(PIoUSurvey/Footage)
<br /> drivew ys-Not over Counter if on publlc roaduVays..needs ROW
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