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813-78Q-002� Ci�y of�'ephiyrhiills�ermi��pplTcat'ron Fax-813-780-0021 <br /> Building Department <br /> Date Received + i� / Phone Contact for Permitting • �c7 ) -� l(.�/ <br /> , ., , J, <br /> _owna�sName 6Y1�-1 `IIM1 .. ._ , _ •�wnerPhone�Nnmher CS�3 t��2"���—JZ � <br /> Ownet's Address q f 5 S Owner Phone Number � i <br /> Fee Simple Titleholder Name Owner Phone Number <br /> Fee Simple Titleholder Address ' <br /> JOB ADDRESS � �V� ���i LOT# � <br /> �UBDIVJSION -RARCELJD# I1-�-2.�-�bl�-- 14200-- I� � <br /> WORK PROPOSED � NEW CONSrR e ADDlALT � SIGN N�vFR�OMPROPERIYT���DEMOLISH <br /> INSTALL REPAIR <br /> P.ROPOSED USE �T SFR Q COMM 0 OTHER ' <br /> TYPE QF CONSTRUCTIQM �Q' 6C�CK Q FRAfNE Q STEEC Q <br /> DESCRIPTION OF WORK PO �� � � <br /> B111k�kNG SFZE •: SQ FOQ�AGE�� kF�IGktT � <br /> -OBUICDIhIG $ �� VALUATION OF TOTAL CONSTRUCTION <br /> QEIECTRICAL $ AMP SERVICE 0 PROGRESS ENERGY Q W.R.E.C. <br /> QPLUM6ING � <br /> QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION � { q v"(- <br /> �QGAS 0 `ROOF7NG Q SPE�IAl7Y 0 (STfdER - <br /> -FINfSHED-FL06R-EL�VAT(ONS �L66DZONE{CREA �YES �!O <br />' $�,4-�R .� � ���� �o�Q�x �'a�t c� n <br /> SIGNAIURE REGISTERED N FEE(:UkkE� N <br /> Address � � Y 1�Y 3 S�-�� Llcense# �(; ( <br /> EkECTRtC1AM_ COMAAN�I <br /> SIGNATUR�� REGISTERED " Y/ N- - FEECURRE� � YPIV' ` <br />� Address License# <br /> PLUMBER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> MECHANICAL COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y!N <br /> i <br /> :Addcess .L�cense,�: <br /> OTHER COMPANY <br /> SIGNATURE REGISTERED Y! N FEE CURRE� Y/N � <br /> _/;N�{fress .L�icer�se# <br /> � i � � � � � i � � ii � � � � � i � � ti � � � � i � � e � � � i � � � � � � � � � � � � � � � � t � e � � � � � � � ii � i � i � <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Fortns;R-O-W Permit for new construction, I <br /> Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, j <br />� Sanitary Facilities 8 1 dumpster,Site Woric Permft for subdivisions/large projects ' <br /> COMMERCIAL Attach(2)wmplete sets of Building.Plans plus a Life Safety Page;(1)set ot Energy Fortns.R-O-W Pennft for new wnstruction. i <br />' 141inimerrr Fen(4Q)wortcirrg days afler sWmittaPdafe. Req�rired onsite,Consttuction Pfans,S[ormwa[er Plarts wf SiR Fence installed, i <br /> =Sanitar�-F�ailities_&:1_dnmpster:9ife.�V+torkl�ettnR�fotall oe�up�ojects:E11Laammetcial requiremeots�mustrrteetLamptiance � <br /> SIGN PERMIT Attach(2)sets of Engineered Pians. <br /> "••PROPERIY SURVEY required for all NEW construcUon. <br /> Directlons:• <br /> Fill out application completely. <br /> Ov;�er&�ConVactor sign bacY,of appltcation,notanzed <br /> If over$2500,a Plotice of Commencement Is required. (AIC upgrades over$7500) <br /> " Agent(for the contractor)or Power oi Attorney(for the owner)would be someone with notarized letter from owner authorizing same <br /> OVER THE COUNTER PERMITTING (copy of contracl required) <br /> Reroafs:if shingles Sewers Service.lJpgrades A/C Fences{PIoUSurveylFootage) <br /> 'Dtiveways=Not ove�Eoufiter if on pUtilic readways:.r�eeds ROW <br />