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,� 813-�eo-ooza Ci af Ze h rhills Permit A lication Fax 813-780-0021
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<br /> Bullding depa�tment _
<br /> Date Received � _ � ; phone-Gantact�far Perrttitf�a �
<br /> Owner"s Name Owner Phana Number
<br /> Owner"s Address • �Owner Phane Number �— �
<br /> Fee Simple 7ltleholder Name �� �� Owner Phone Number '�— �
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<br /> Fee Simple Titleholder Addres� ' � -
<br /> JOB AbDRE8S LOT# C�
<br />'i SIfBDIVISION � . . � PARCEL ID#
<br /> . , (OBTAINED FROM PROPERTY.TAX NOTICE)
<br />� WORK PROPOSED , � _NEW CONSTR ADDIAIT � SIGhi' Q � t3EMOI:ISH
<br /> - -.e, INSTALL 8 , REPAIR
<br /> PRQPC►SED�USE Q SFR- Q CQMtUI ��,� C1THE12 ° ,
<br /> TYPE OF CONSTRUCTION" ` Q� BLOGK " Q FRAME � [� STEEL Q
<br /> DESCRIPTION OF WORI( �. � C. �
<br /> I BUILDING SiZE �� �"'$Q,F�OTAGE�__�. ,HEit3}1T���_� �� .
<br /> QBUI�DING �_� � ..,.�._-. . �-� . . . .
<br /> VALt1ATiON:t7F TOTAI CONSTRUCl'ION -
<br /> QECECTRIGAk '�f � AMP SEF2t110E Q PROGRESS ENERGY Q "W:R.E .
<br /> QFLUMBlNG $ f�
<br /> �� �: �
<br /> OMECHANlCAL $ VA�UATION OF MECHANICAL INSTA�I.ATIt3N �
<br /> QGAS 12QOFING .Q SP,ECtA1.TY � OTHER ��
<br /> FINISMED FLOOR E�EVATION � FLOOD ZONE AREA [_]YE$ ,NO
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<br /> BUILDER COMPAfiIIf�� � ' '
<br /> SIGNATUR EGISTERED Y/ N FEE CURRE� Y/N .
<br /> lAddres � � .;.,� ' �License# [ �" I
<br /> EtECTRICIAN: a:,CON1PfWY': ; ` _-� ''`k' � � � _
<br /> SIGNATURE �` REGISTERED Y/ N FEE GURREM�' ``�'-=Y/N "
<br /> Address , . . .. ;� , r�� �'License,#:{ �" � ; ..�. - �
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<br /> P�UMBER ` ' COMi?ANY � :j �
<br /> SIGNN►TURE' `` ' REGISTERED Y.IF.Nu t _ ��FEE_CUF2REA;, � � Y�/N. '
<br /> , . - . _ .�., , - ... - . "�
<br /> Address � .� ;License,;#��.� • � � �' i,
<br /> 1 , ., - , . < - _ r
<br /> � MECHANECAI: COMPANY
<br /> SIGNATURE - � � � ee�isreReo Y_/ N . ,_ � �eE cuwzEn: . Y�/-N- � ,
<br /> � Addrsas ' - - .. , , - �- , � ` License#�� ... ._� f + � -
<br /> OTHEE2 ., � �� ' _ �GOMFANY , ,
<br /> StGN/1TURE . - ' ' - � ' ' � REGIS7ERED; Y/ N..� �FEE�CURRE� ' Y/N .
<br /> Addies�} y, , t• - ._ ' . License# � ' �
<br /> .. _� }.,.�:....,...:,. ,,�...� :�:_ � = �
<br /> RESIDEN'f1A1:":.� ;Ai#a�'{2}„P!o#=P-.lans:(2)sets�o�f8uildi"ng}Plaris;`{1)seta�Ene�}y�Foiirrs;�R�O-iNPeris�i#fornew�constructioa,
<br /> ,�, �:=Minimum,ten,�(:10);workirig,tdays after'submlttal d"ate:.:}tequirei!onslte;:Constrtictlon'.Flans;�$tormwater Plans w/31tt'Fence instailled,
<br /> �."��• Sanitary FacfliUes�;&�.1a;dumpster.,Site�Worlc:Permit•for'sutidiVisto�sllarge:proJeots,F.,-j=;-;: ' ' �'
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<br /> C4MNIERCIAI. Attach{3}cbmptete sefs'of Buitiiing Pians pius a��ife Safety Page,�{1)set cf Energy Fotms.R-O-W Permlt#ar new consfisction.
<br /> Minlmum ten(10)working days after submittal date. Requfred onsite,CansUuctlan Plans,Stormwater Plans w/Sflt Fence installed,
<br /> Sanitary Facilides&1 dumpster.Stte Worlc Parmlt for all new:proJect"s:_All commercial requlrements.must maet camp!lance �
<br /> � StGN PERMfT Attacti{2}sets of Englneered;.Plans.,;�-; ,. _ �, �: :'_ - - , - `
<br /> , •••'PROPERTY SURVEY reguiracl for all,NEW aanstructlan.. -
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<br /> ' Directtans: . j�-..,_;, , ,
<br /> � Fill out applicatlan completely.
<br /> Owner 6�Contractar sign bacic of applicatton,notarized
<br /> tf over 52500,a Notice c�f Commencement ls required. (AlG upgrades over S750dj �
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<br /> '• Agent(for the�contractot)brPower of Attomey(fair tFie owner)would be�someone with nota�zed letter from owner authorizing seme �
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<br /> OVER'i'FiE CCIUNTER PERMi'iTTiNG --.••(Front of Appticatian=On{y} - '
<br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(PlobSurvey/Footage) _
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<br /> Drivsways-Not aver Counter if on public rosdways..need"s ROW "
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