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Building Department <br /> )ate Received Phone Contact for Permitting <br /> owner's Name 1'Lj+C � Ofl1C L�l) )G{.Ilc (-LC, , Owner Phone Number <br /> Owner's Address 2U�r2 s' �a��-Gl��urL dl 0'd0 L Owner Phone Number <br /> Fee Simple Titleholder Name /r v Owner Phone Number <br /> Fee Simple Titleholder Address -1 J <br /> A <br /> JOB ADDRESS (,L'`l -/6 oI�U�-[:/`l p'- L/v If/C/!-uh Y �r�S I/ LO13�T f <br /> SUBDIVISION Ow�s D PARCEL ID# OqI <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED NEW CONSTR ADD/ALT 0 SIGN Q DEMOLISH <br /> ® INSTALL 8 REPAIR <br /> PROPOSED USE ® SFR 0 COMM OTHER <br /> TYPE OF CONSTRUCTION J 1'BLLOJ7CK �n0 FRAME u STEEL = <br /> DESCRIPTION OF WORK GV vv n S <br /> BUILDING 512E SQ FOOTAGE � HEIGHT <br /> =BUILDING $f�jLr a /{r0 VALUATION OF TOTAL CONSTRUCTION <br /> =ELECTRICAL $ l /� 7 N� AMP SERVICE 0 PROGRESS ENERGY 0 W.R.E.C. <br /> PLUMBING $ I -7I190 �J <br /> =MECHANICAL l$ VALUATION OF MECHANICAL INSTALLATION <br /> 6J J6•�f� <br /> =GAS = ROOFING = SPECIALTY = OTHER <br /> FINISHED FLOOR ELEVATIONS �{� ) FLOOD ZONE AREA =YES NO <br /> u/ t <br /> BUILDER COMPANY tIle /fv� ►L C. r]INLnG I LL <br /> SIGNATURE REGISTERED Y/ N__J FEE CURREN Y//N <br /> Address 5, 41 te t1bv I(lWmc)1 ` License# <br /> ELECTRICIAN COMPANY <br /> SIGNATURE Q/y REGISTERED Y/ N FEE CURREN Y!N <br /> Address l h l� /v, L <br /> License <br /> PLUMBER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURREN <br /> Address 3133/►/�3� ��GJI�L6Gcr/uA�l�L378� License <br /> MECHANICAL COMPANY 9&4S & dyd/him14 <br /> SIGNATURE REGISTERED Y/ N FEE CURREN Y/N <br /> R/3 i7Gnt6Y7 f=hll� GtSLy?,FL 341 cp(�7 License# 3 Z� <br /> Address <br /> OTHER /ru COMPANY <br /> SIGNATURE p, REGISTERED Y/ N FEE CURREN Y/N r— <br /> Address / �r i � 3r License# <br /> Illlllf .11llllllllfllllllllllfllllllllll11111111IIIIIIIIIi1lI11111111 <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction, <br /> Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities&1 dumpster;Site Work Permit for subdivisions/large projects <br /> COMMERCIAL Attach(2)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction. <br /> Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities&1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance <br /> SIGN PERMIT Attach(2)sets of Engineered Plans. <br /> ****PROPERTY SURVEY required for all NEW construction. , <br /> Directions: <br /> Fill out application completely. <br /> Owner&Contractor sign back of application,notarized <br /> if over$2500,a Notice of Commencement is required. (A/C upgrades over$7500) <br /> ** Agent(for the contractor)or Power of Attorney(for the owner)would be someone with notarized letter from owner authorizing same <br /> OVER THE COUNTER PERMITTING (copy of contract required) <br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage) <br /> Driveways-Not over Counter if on public roadways..needs ROW <br />