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Building Department <br /> ate Received z- 10 <br /> Phone Contact for Permitting 1:9 1 , ) �? -- 1`6 <br /> N,,' A a 1 2_ - <br /> lwner'sName Poic (laR1L L�'n� )Gl.11 �� Owner Phone Number <br /> 1wner's Address v1,�z S, F414-,i bur 0, 1 I�Q obi t�[,t� L Owner Phone Number <br /> ee Simple Titleholder Name / Owner Phone Number <br /> ee Simple Titleholder Address !A <br /> OBADDRESS �D Z vD &,,9 S �l l m)/ ' LOT# <br /> UBDIVtSION D1 ,1�s 0 J� PARCEL ID# <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> VORK PROPOSED ® NEW CONSTR R ADD/ALT SIGN = = DEMOLISH <br /> INSTALL REPAIR <br /> 'ROPOSED USE ® SFR. 0 COMM OTHER <br /> YPE OF CONSTRUCTION BLOCK 0 FRAME STEEL = <br /> )ESCRIPTION OF WORK �GV L�(J n S (,�G]ll f S�� tJif !l <br /> BUILDING SIZE r � SQ FOOTAGE rat /� HEIGHT ? <br /> =BUILDING $ lP�/�� VALUATION OF TOTAL CONSTRUCTION <br /> =ELECTRICAL $ AMP SERVICE 0 PROGRESS ENERGY Q W.R.E.C. <br /> =PLUMBING is <br /> =MECHANICAL $ / VALUATION OF MECHANICALSINEALA ION <br /> =GAS 0 ROOFING Q SPECIALTY = OTHER <br /> =INISHED FLOOR ELEVATIONS /�� D , r FLOOD ZONE AREA OYES NO <br /> fIA- <br /> BUILDER /F <br /> COMPANY <br /> SIGNATURE '` , r' <br /> REGISTERED Y/ N FEE CURREN p, Y/�N <br /> WAS',AS',6l I►s� f � 11/EIl/ w, , License# L l G ice?lam •(�I <br /> ELECTRICIAN COMPANY <br /> SIGNATURE y REGISTERED Y/ N FEE CURREN L11N <br /> ' as l 11 [CL / CCU a/"I`-� ` License# E� co, J t) <br /> Address f <br /> PLUMBER COMPANY `v a' '/y� <br /> SIGNATURE / REGISTERED Y/ N FEE CURREN <br /> Address 3133��3 /�r/G6alad,FL License# 1 7-1 -7-7 <br /> 9. <br /> ` L j <br /> MECHANICAL I COMPANY 9d/46 AW �+-'`L/(� !/ .l$ ��/1 <br /> SIGNATURE REGISTERED Y/ N FEE CURREN Y 1 N <br /> f{/3/�GrLt6�'7 Address l� dSLJ?,FL License# I % /. 3 269 <br /> OTHER COMPANY "D <br /> SIGNATURE p, �� REGISTERED Y/ N FEE CURREN Y/N <br /> Address li93/�/y/in l�r 2cAJ Ui?` /chi F�,3 License# I <br /> 1. tilts .r..Arrfiiliii .i .rrllAArrrlrildiliA0rr11ili1ArAliiAAAi11:1tA1AiiYrrA <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 />