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813-780-0020 City of�epfiyPhiils Permit Application Fax-813-780-0021
<br /> Bullding Deperlmenl
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<br /> � D'ate t2ecelded "
<br /> ':% �--mTt_� . . _..... .,..-- ....._.. ..._.... .Phooe Corilacl tor Perml[tin'
<br /> Owner's Name. 1.I . �te �!-�,{r�c�G�_ p Ph N �
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<br /> OWner'9 Ad'dre'ss' .�3� S'�', ,, � ,�� ONineF f'hoite Nurriber .....
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<br /> Fee Sli�ipte Tllleholder Nerris ... _ .. . ... ._. ........._ O�vrier PKofle Numhti . �.,. .
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<br /> Fee 8lmple Tllleholder Address ,. ..... .. ., .._ .....
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<br /> JOBADDRE95 6.� . , .. �iIJ•S, . . .r_JrJS,`1�-' �
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<br /> PARCEI IDH ..:.��..����Q! .,"Q._. .:U
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<br /> SUBDIV1810N .. . ...... ..� ... ..... ..
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<br /> (OBTAINED FNOM PRUpERTY TAI(NOTICE) � "
<br /> WORK PROPOSED NEW CdNSTP ADDIALT SIGN
<br /> B IN97ALL 8 REpQIR � O � DEMOLISH
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<br /> 0 COMM . .. . . . ...... ... . ...
<br /> PROPOSED U&E Q SFR OTHER " "
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<br /> 7YPE OF.CONSTRUCTION • Q BLOCK Q FRAM� � STEE� Q
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<br /> - DESCRIPTION OF WORK �V� _ ./:"� R. c(�.. . r10UQi�. _ . _ C.LC.� �J. . .-:" (/v c.�[L��
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<br />� BUILDINO 81ZE . . �..... 9Q FOOTAGE .. . ..... . HEIOHT ._..
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<br /> QBUILDIN� $ �'' �� VALUATION OF TOTAL CONSTRUGTION
<br /> �ECTRICAL $�'"� ' ' AMP SERVICE " � pROGRESS ENERGY � W.p.E.C.
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<br /> QPLUMBING $" " `���
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<br /> OMECHANICAL $ ' '" " ' '" " VALUATION OF MECHANICAL INSTALLATION �
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<br /> QOAS Q ROOFING Q SPECIALTY � OTHER /�j/f� �
<br /> FINI9HED FLbOR EL�VATIONS FLOOD ZONE AREA �.�YES NO ��/
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<br /> BUILDER COMPANY _ ... _.,..._......_,
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<br /> SIONATURE . ...._. .... . . '..... ... aEcisYeaeo Y.f:N... FeecuaaEn " -.YLN_. .
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<br /> Addreee ;: ..._. _ .. _ . .. .__.__._.,...... . Llaense fl ................. .. -
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<br /> ELECTRICIAN , '60MPANY ���/.V../L. .._ C.:7 �Z i G�
<br />� 910NATURE ._ � _ .. .. . . .. .. REOISTER�D � Y I N... �EE dURRE�� �.Y I N. � "
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<br />�' Addrees ��.7�! , �17U .... ._ .... � . ....� lJcense# �(����Go�.-l•. :
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<br /> pLUMBER • COMPANY
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<br /> SIGNATURE . . . .. , ., . .RE616TEHED � .Y I N.: ��� FEE CUftREA ��Y/N,. �
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<br /> MEGHANIGAL COMP.ANY
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<br /> SI(iNATURE aEals7Eaeo _YC,N..: FE�cuaaEn .Y.lN.
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<br /> OTHER , COMPANY
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<br /> SIGNATUR� _ . .'., ,.. _ . _. :.... . . .. ,� _, REOISTERED Y�/ N� � kEeCuahen ' Y/N�
<br /> Address . . ... . ... .. .... . .. License# ._. .. �
<br /> � � i �.ii � � � � iiiii � � i � i1.it � (� � iiiii � iiiiii � Iliii � i � l � ii � i �� � � � � � � i � � iii
<br /> R�SIDENTIAL Allech(2)Plql Plans;(2j sels ot Bulldlrig Pleit�;(t)sel of Eriergy Fortns;R-O-N('Pe�ml(for neu4 construcllon,
<br /> Mlnlmum len(10)working deys'afler§ubmltlal tlele. RequlFed onslle,Conslhicllon Plans;"Slormwalet Plens wl.SIII Fenee Inslalled,
<br /> Senllery Fecllllle§8 9 dumpster,Slle Nlork Permll tor subdl'vl'slon"sAerge proJecls '
<br /> COMMERCIAL Allach(2)complete aets oi Bullding Plens plus e Llfe Safely Page;(1}se(of Eneigy Forms.R-O-W Perinll fo�neW conslrucllon.
<br /> Mlnlmum len(10)workfng days atler submlllal dale. Reyulred anslle,Conslruotlon Fleris,Slortiiwaler Plens wl Sllt Fence Inslalled,
<br /> Se�Itery.Fecllllles fl 1 dumpsler.Slle Wbrk Permlt for ell neNi proJecls.All cammerclal reqLlreinenls must meel compllsnce
<br /> 51GN PERMIT Allech(2)aels ol Englneered Pla�s: �
<br /> ""PROPEFtTY SURVEY requlred for ell NEW consliuc(lon.
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<br /> �.-�.�i��F�1�1�:%%r''.�:�1=L=�.��yi .,�,_�_.�;;���- .�..�-�-�-:�.�-.-�-- •-14%{-1-i+'. �-.-�._.-_._� +. . '.'"....-Tr..�
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<br /> • Dlrecilohe:,
<br /> FIII oul ePpllaellon cbmplelely.
<br /> Owner 8 Conlrectar'slgn lieck 6f eppllcallon,noleriied.
<br /> If ov6r 52600;a Nollcs oi Gdmmencameht le reyulred. (AIO upg�ud9's oveP 57800)
<br /> " Agenl(for Ihe conlraclor)or.Povier of Altorney((or Ihe owaer)would be someone wllh nolerfied laper from owner authedzing seme
<br /> OVER THE COUNTER P@RMIITING (copy of ca�l�ecl r�qulred)
<br /> Reroote If sFiinglas 3ewers Servlce Upgiedes A/C Fences(PIoVSurvey/Footage) -
<br /> Drlveways-Nol ov@r Counler If on publlo roedweys..needs ROW , �
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