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<br /> �-�8��-�eo-oozo Ci of Ze h rhills Permit A IIC�tI0C1 Fax-813-780-0021
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<br /> 1 Buitding Departrnent' ,
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<br /> Date Receltired � � � � -
<br /> i- Piione Cantact`far Perm{ttin -- � —
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<br /> Owner's:Nam� t�111rl.t -:� - '.;�h-P" �G.���'`� .-. ��ner�hone�Nnmb�F=,w� �.��`�'��`rG�a'7�
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<br /> " Owner•s Add�ess � }� ' ,- �' tl - � r""�� �45 � � ,OwnerPhone-Idumbsr �
<br /> Fee 8lmple T�tleholder Namc+ � Owner Phane Number � �
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<br /> .fFee5lmple.Ttleholde�Address _ _ ''' �. .., �� � _
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<br /> JOB ADDRE�rS 6 � !�'�v. P' �• ��/� ' Y'Lt�T�
<br /> SUBDIVISIOI�1 V�ARCEL ID# '
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<br /> (08TAINED FROM PROPERTY TAX NOTICE).
<br /> WORK PRO OSED NEW CONS7R ADD/ALT ��� SIGN Q Q DEMOI.iSH -
<br /> e" ` IIVSTALL .8, ..REPAIR
<br /> PROPOSED�SE FR COMM OTFiEiT
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<br /> TYPE QF CON3TRUC710N" Q� BLOCK '' Q FRi4ME [„� STEEI. Q �� , - - ` - '
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<br /> DESCRIPTIO OF WORK �L'�� — -�,r?��TG•'--/ef �
<br /> BUILDIN�,�91 E SQ F007AGE�� HEIGHT ,.
<br /> BUtLDING �� _lr___�VALUATION ll�F�TO7AL CONSTRUC710N _
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<br /> QEL CTRICAL, $ AMP SERVICE � Q PROGRESS ENERGY Q W.R.E.C.
<br /> QP� MSING �� , . � `
<br /> QMECFfANtCA� $ VAl.UATION OF MECHANICAL 1NSTALlAT10�! r'' �
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<br /> QGAS [,� , ROOFING. � SPEGIA�:TY � � �OTHER � � �P �r
<br /> FIfVISHED F I OOR ELEVATIONS ���- FLOOD ZONE AREA �]YES. NO
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<br /> �UILDEI2 COMPANY
<br /> SIGNATUR I REGISTERED Y/ N FeE CURttE� ,Y/N
<br /> Addres Cicense# � � I
<br /> ELECTRICt � � CC►MPANY '
<br /> SIGNATUR ���' REGISTEREp Y/ N FEE GURREP Y/N
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<br /> Address = , 'License#
<br /> PLUMBER � , - COMPANY° �
<br /> SIGNATUR� .. REGIS.�RED "-Y/w.N � FEE CURREA - Y/N.
<br /> Addre - Licsnse#.j �
<br /> MECHANIG ' .. .� � - Gti1MP�P�Y �
<br /> SICiNATUR� " � REGISTERED .Y:/ N FEE CURRE�` Y/;N .
<br /> Addre s��' •- • � License# � �
<br /> OTFtER . � ' � " � , COMFANX -
<br /> SIGNATURE . ` � � � ' `�� � REf31STERED Y/ N � ; - �e CUR�� ., Y:/N .
<br /> Addre�s;5 - - . , _ � ' i:icense#
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<br /> REStDENT,Ai;: "`�Attacfi,(2):.P1of�Pians;;(2)`;s`ets=of+Buitiling;Plans;�('i}'�sef of°Eiiei�gjr�Fortris;,R-O�W Fermit for neyy,c6nstrucUon,.
<br /> � Minimum�ten�;(1„�q);virorking days�after,�"s,utimittal�tlate:t Requl�ed onsite;�Gonstniotlon Plans StormwateF'Plans w/Silt Fence installed,
<br /> . ., .,Sanitary'�acNtUes.;&a'ty;dumps.ter;Sltet,WoiltwPecmlt_for:subdiv[s4ocisllarge,Projeds`_;:°:u,�;w. ,,-"�,;; - °
<br /> CQMMER�{AL Attach(3}�complete sets of Bi�it�irig Plans pius a'tife Safetyr Page;(i}set of Energy Fottns.R t}-W Pennit for new canstnsctlon.
<br /> � Minimum ten(10)working days after submithal date. Required onsite,.ConstrucUon Plans,Stormwater Plans w/Silt Fence instailed,
<br /> 5anlfary FacfiiBes&1 dumpster.SitB Work Petmit far,�ii'neuv!proJeots:Al{cammerc+al.requlrements must meet compllance
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<br /> SIGNPERifAiT Attacti(2)�setscf�Enginear,ed;Plans;:�a.:�:;;-.:` ..r.;;- �.:'.,�. • �
<br /> � � •`"•PROPERTY SURVEYrequlred fo�all NEW construction.. . •
<br /> Directions �>t�,,. � . - �
<br /> FIII ou applicat(on completely. �
<br /> t}wr�e &Contractar.slgn back�of appitcatlon�notarized - -
<br /> ' If ove $a500,a Notice of Cammencement ts requlred. (A/C upgrades over�7SO4j , _
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<br /> " Agent(for ttie ccntractor}`or:Power of Attaiiiey(for tYie'ovurierj would'be�someone�with notadzed letter from awner authorizing same
<br /> DYERTH COUNXER;P.E�tMITTIWG -.-,.::,(Front.of�AppifcationOniy).- . - _:` .:.��' ; �
<br /> � Reroofs if s ingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Fcotage)
<br /> a.:.��••�e—•.�' ;,'`Y"t�'{I'�'x •' S Y C ..
<br /> Drive ays-Nak over Counter if on public roadways..needs RQV1i '
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