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�- Fax-813-780-0021 <br /> i .._... <br /> � ' 11 � � . <br /> ° Phone Cont�ct toe Permitttn �- � _ , <br /> �- � <br /> _.�reame � <br /> ` Ou�rn�r Phone Plumiser <br /> Owner's�lddress ��� � ����c�J c3�'• �i I�Y�� <br /> , Owner Phone Numb�r <br /> Fee Simpl�7ltleholder Nam� Ownee Phone I�umber <br /> Fee S(mpl�Tftlebolder�4ddress <br /> JOB�DRESS 1 c � � � - LOT# �� <br /> �UBDIbESIOi� ��'�j � ��CEL ID# ��I- � � � I " ���� —W� � d�a� <br /> (OBT/SlNED FROl49 PROPERTYTAX NOYICE� <br /> WORK PROPOSED NEw CONSTR ADD/ALT [� SIGfiI Q [� DEMOLISH <br /> e INSTALL 8 REPAIR <br /> PFtOPOSED:USE Q SFR Q COMM �] OTHER <br /> �F�E OF�O�IS�RtlC'PIOPf Q BLOCK ' Q FRAME � STEEL Q <br /> ��sc�i�v�o�o�wo�� �Y Y1 I Q1n. � <br /> BUILDIRIG SI�E SQ FOOTAGE�� HEIGIiT <br /> OBU1LDIiVG � _ <br /> , . VALUATION`OF l'OTAL COfVSl'RUCTIOPJ <br /> QELECTRICAL $ " AMP SERVICE �] PROGRESS ENERGY [� W.R.E.C. <br /> OPLUMBING $ , �� . <br /> OflhECHANICAL $ VALUATtC�v OF A4cCHANIGAL INSTALLATION �D <br /> . . ,� (� b <br /> OGAS Q ROOF[tdG � SPECIAl.TY Q OTHER <br /> FINISHED FLOOR ELEVATIONS FLOaD ZONE AREA QYES NO (�,{� <br /> ���. <br /> �UILDER COhAPAPtY <br /> e�r_uevi ioe <br />� "•"••'�•"••` REGISTERED Y/ N FEE Clle2.Rc� Y 1 s°i <br /> Address License� <br /> ELECTRICI�f COIWPANY <br /> SIGRlAYUPiE � REGISTERED Y/ iV - FEE CURREl� Y!i� <br /> Adc➢r�ss <br /> • Ucense.# . <br /> PLUMBER COfYiPA�fY T V If� i .I , �I V1 / <br /> SIGWA'TURE REGISTERED Y./..N FEE CURREA Y <br /> �dldre�s •�i License# L�- � ' <br /> WJECHARIIC�L CONflPAP1Y - � <br /> SIGP1ATl��E REGISTERED .Y/ i�! FEE CURREA- Y/N _ - - - <br /> klddre�s License# � <br /> OYH�R COAAP�IWY . <br /> SIGRIATURE REGISTERED Y/ fV FEE CURRE� Y/N � <br /> �ddress � Llcense# <br /> L41�SlDER9YIAL _ �Attach(2)RIof.Pians;.(2)`sets of Building�Pians;(7)set of Energy�Foims;R-0-W Permit for new canstruc6on,. j .� - <br /> � _ Minimum:ten{10)working:days.after;submitfal date. Requlred onsite,.Constiucdon�Rlans;Stomiwater Plans w!S�t Fence en„�fied, <br /> San(tary Facilides&1.dumpster_S(te Work•Permit for subdivisionsAarge projects <br /> COAflHA�F2ClllL Attach(3)complete sets of Buildirig Plans plus a Ufe Safety Page;(1)set of Energy Forms.R-O-W Permit for n�yr coss,,.�,r�:a-6 <br /> Minimum ten(10)worktng days after submittal date. Required onsite,Construc8on Plans,Stormwater Plans wl Silt Fence i-ss��, <br /> Sanitary Facilities&1 dumpster.Site Wark Permit for all new projects.Ail commercial requfrements must meet comp6arice "' <br /> SIGPI PERMI�' Attach"(2)sets of Engineered Plans. _ - <br /> "'•PROPERTY SURVEY required-for all NEW construction. - . <br /> Dir�ctlons: <br /> Ftll out appitcatlon completely. <br /> Owner 8 Contractor sign back of applicaBon,notarized • <br /> If ovee$2508,a Pto4te�of Comm�ncem�nt ds r�quired. (AIC upgrades over$7500) , <br /> i, <br /> "` �:�t(far the contractor)or Power of Attomey(for the owner)would be someone with notariaed letter from owner authorizing same <br /> ' :='�.{:���^L.F�iTER P�RlAITTING (Front of-Appllcation Only) <br /> =�_�-.� �� Service Upgrades A/C Fences(PIoUSurvey/Footage) <br /> �,irw�u�t,.:�-,�x:;��;����eeds ROW _ ' <br /> ..,, -.,>,,:. . " � .. <br /> '_� . _c:Y?:a v�y`' . . . <br /> , .,.•— �--- --------�----__ —'_._.- ,___ _ __ _. . <br />