|
<br />813-780-0020
<br />
<br />
<br />, City or Lepnyn 1111::) rtllllllL n........II\JUm.l11
<br />Building Department
<br />
<br />1'1Q
<br />Tko
<br />
<br />Owner's Address f tJ~'
<br />Fee Simple Titleholder NamJ
<br />
<br />Date Received
<br />
<br />Fee Simple Titleholder Address I
<br />
<br />3~1L( '.3 7/;;./2..
<br />
<br />7~' V<=-
<br />, PARCELlD#1
<br />
<br />Owner Phone Number
<br />
<br />Owner Phone Number I, '
<br />
<br />owner phone lIum~r I , ~~
<br />'; ~'tS"c:H_
<br />
<br />\ \ -2(,;, - 2\_bO\O- \Col.\<lD-CO
<br />
<br />LOT# I I.
<br />
<br />\\ -ala -;2\ - (:)0\0-\'"39.00-' O~lot
<br />(OBTAINED FROM PROPERTY TAX NOTICE) ,0 'i5UZ-
<br />SIGN D MOVE 0 DEMOLIsH
<br />
<br />-'../,
<br />+A1~T~I/, 2.1~1
<br />I
<br />
<br />I
<br />
<br />Owner's Name
<br />
<br />BOx
<br />~
<br />
<br />zr;~~~:L I
<br />
<br />JOB ADDRESS
<br />
<br />SUBDIVISION
<br />
<br />, E3 NEW CONSTR r=:J' ADD/ALT 0
<br />INSTALL CJ REPAIR
<br />PROPOSED USE 0 SFR 0 COMM 0 OTHER F~^,ee
<br />TYPE OF CONSTRUCTION 0 BLOCK 0' FRAME 0 ,STEEL D OTHER I
<br />
<br />DESCRIPTION OF WORK I To IJv r/?::/( 1{()r.(tI NO/5"e V- ~q Il.. ~ )/s-t 1'5' _'if? /)tJ.'J
<br />
<br />B~=E '1221' )./1'(, ~~ I ,SQ'FOOTAGEI' " . I HEIGHT I . . I', "
<br />
<br />. , . . . , , 0 , . , , . . , . , 0 . , 0 . 0 , . 0 0 0 . , 0 . 0 0 0 , , 0 0 . . 0 . : , 0 . 0 . 0 0 . 0 . 0 ~ 0 . 0 . 00 . 0 . 0 0 0 0 0 0 0 0 0 . . 0 0 . 0 . 0 0 0 0 . . . 0 0 0 0 0 0 . 0 0 . 0 0 . 0 0 , , 0 0 0 . 0 0 0 0 . 0 , . . . , 0 , 0 0 . , 0 0 0 . 0 , . , , . , 0 . . 0 0 . , , 0
<br />
<br />D BUILDING 1$ VALUATION OF TOTAL CONSTRUCTION
<br />D ELECTRICAL 1$ AMP SERVICE , D PROGRESS ENERGY 'D
<br />
<br />D PLUMBING 1$
<br />
<br />D MECHANICAL 1$
<br />
<br />D , GAS D
<br />FINISHED FLOOR ELEVATIONS I
<br />
<br />WORK PROPOSED
<br />
<br />W.R.E.C.
<br />
<br />VALUATION OF MECHANICAL INSTALLATION
<br />, '
<br />
<br />ROOFING
<br />
<br />o
<br />I
<br />
<br />SPECIALTY 0
<br />FLOOD ZONE AREA
<br />
<br />OTHER,
<br />
<br />DYES
<br />
<br />DNO
<br />
<br />. . - . .
<br />, , I I I , I I I I I I , I , , , I . I I I . . I I , I , , I I . . I I I I I . I I I . P , . I , I I I I . I I . I I . . . , . I . I . . . . , . . I . , , , . , , . I . I . . , , . . . ~ . I . I I . . . I , . . I I I , I . . , . I . . . . . . I I , I I I . , I . I I I . . I ~ I . . I I I I
<br />
<br />Address
<br />
<br />
<br /> /
<br /> YI N' FEE CURRENT
<br /> License #
<br /> YI N I FEE CURRENT
<br /> L1cens~ # I
<br /> '/
<br /> YI N FEE CURRENT
<br /> License #
<br /> Y/N FEE CURRENT
<br /> License #
<br />COMPANY
<br />REGISTERED YI N FEE CURRENT
<br /> License #
<br />
<br />ELECTRICIAN
<br />SIGNATURE
<br />
<br />Y/N
<br />
<br />I
<br />I
<br />I
<br />I
<br />I
<br />I
<br />I
<br />I
<br />I
<br />I
<br />
<br />BUILDER
<br />SIGNATURE
<br />
<br />I Y/N
<br />
<br />Address
<br />
<br />PLUMBER
<br />SIGNA lURE
<br />
<br />Y/N
<br />
<br />Address
<br />
<br />MECHANICAL
<br />SIGNATURE
<br />
<br />Y/N
<br />
<br />Address
<br />
<br />OTHER
<br />SIGNATURE
<br />
<br />Y/N
<br />
<br />Address
<br />
<br />RESIDENTIAL
<br />
<br />, 'I '
<br />Atlach (2) Plot Plans; (2) sets of ~ulldlng Plans; (1) set of Energy Forms, ,
<br />Minimum ten (10) working days after submlltal date. Required onslle. Construction Plans, Sanitary Facilities & 1 dumpster
<br />Attach (3) sets of Building Plans; (1) liet of Energy Forms. "
<br />Minimum ten (10) working days a~er submittal date. Required onslle. Construction Plans, Sanllary Facllllles & 1 dumpster
<br />All commercial rE!qulrements mus, meet compliance.' ' , .
<br />Attach (2) sels of Engineered Pla~s.
<br />....PROPERTY SURVEY require for ali NEW construcUon.
<br />
<br />COMMERCIAL
<br />
<br />SIGN PERMIT
<br />
<br />, DIrections:
<br />Fill out appllc;allon completely.
<br />Owner & Conlraclor sign back of application. nota?zed , . , , '
<br />.. If over $2500. a Notice of commjncement Is re~ulred. (Ale upgrades' over $5000)', ., ,
<br />Agent (for the contractor) or powe~1 of Attorney (forr the owner) would be someone With notarized letler fro
<br />OVER THE COUNTER PERMITTING (Front of Appllcallon Only)
<br />Reroofs Sewers Seo/lce Upgrades NC Driveways Fences (PlciUSurvey/Fodtage)
<br />I
<br />I
<br />!
<br />
<br />"
<br />
<br />ame
<br />
<br />
<br />
|