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_ ---- uay oT /_epnyfhU|SPerm1t Application Fax-813-780-0021 <br /> Building bepartment <br /> Date Received Phone Contact for Permitti g <br /> owner's Name Ow ier Phone Number <br /> Owner's Add r.'SS Owner Phone Number <br /> Fee Simple Titleholder Name -sn Owner Phone Number <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS 5 �,k,-,C,C?_� -Dvi\f? D ID�)u I- LOT# Rom I <br /> mUaoN1nxON pARoELKD# <br /> (OBTAINED FROM PROPERTY NOTICE) <br /> — <br /> WORK PROPOSED woyoomsrm 8oD�J]' �--1 s\GN F--) �—� DEMOLISH <br /> 115' <br /> INSTALL R <br /> REPAIR <br /> PROPOSED USE �—� . SFR 7--1 COMM �--7 OTHER <br /> TYPE OFCONSTRUCTION BLOCK �—� FRAME �--1 STEEL F--\ <br /> DESCRIPTION OF WORK 1 <br /> `+ <br /> BUILDING SIZE SQ FOOTAGE f4_ HEIGHT <br /> =BU(LD|NG VALUATION OF TOTAL CONSTRUCTION <br /> �--�ELECTRCAL AMP SERVICE F--� PROGRESS ENERGY �—1 YY.plE.C. <br /> ___ <br /> =PLUMB|NG <br /> �—��ECHANk�\ �AL\N8T��L�ODN ��� <br /> �__^ _ '—�� *' <br /> �—�G�s ���' ROOFING �—1 � SPECIALTY OTHER <br /> DTHER <br /> ��� <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YE8 NO <br /> 07 <br /> BUILDER COMPANY <br /> SIGNATURE nsG/orsnso Fseconneu L_y���� <br /> Address License# <br /> ELECTRICIANC)eR I <br /> COMPANY <br /> SIGNATURE �so/orsoso L���L� FssounREh LY_��_J <br /> Address License# <br /> PLUMBER COMPANY <br /> SIGNATURE Rsoonsnso LY/_N_ 'pssnonnt^ L]!/N_� <br /> Address Ucense# <br /> MECHANICAL COMPANY <br /> SIGNATURE REGISTERED ` L����_| psecunnsx [Y/_NLJ <br /> Address � License# <br /> OTHER COMPANY <br /> SIGNATURE nsa/orEnso L�2��_| rEsounnEx L_Z LNL_�J <br /> Address Licenoe# <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set nf . <br /> Minimum ten(10)working days after submittal date. Required orisite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities&I 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(1O)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans wl Silt Fence installed, <br /> Sanitary Facilities&I dumoster.Site Work Permit for all new projects.All commercial requirements must meet compliance <br /> SIGN PERMIT Attach(2)sets nf Engineered Plans. <br /> °°°°PROPERTY SURVEY required for all NEW construction. ' <br /> Fill out application completely. <br /> Ovmnr&Contractor sign back of application,notarized <br /> If over$250o'allotine of Commencement is nv9qimd. (A/C upgrades over$J5UV) <br /> °~ <br /> Agent(forib000ntractor)nrPovwerofAttxne�0orthanwnmjwmo|dbeoomeoneWithnobydzad|eUorfromowmereuthohzinAsama <br /> OVER THE COUNTER PERMITTING (copy of contract required) <br /> Remofsifshingles Sewers Service Upgrades A/C Fenmm(P|ot/Gumey/Foobge) <br /> Driveways-Not over Counter ifon public moUvays..000deROW <br /> ' . <br /> ` ^ <br /> ` - <br />