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<br />~ <br /> <br />813-780-0020 <br /> <br /> <br />Fax-813-780-0021 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Blvd <br /> <br />Owner Phone Number <br /> <br />Owner Phone Number I <br /> <br />Owner Phone Number I <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name I <br /> <br />JOB ADDRESS <br /> <br />Fee Simple Titleholder Address I <br /> <br />I s.;r: 3 If G c.. II <br />I <br /> <br />NEW CONSTR <br />INSTALL <br /> <br />Blvd <br />I <br />B <br />.~ <br />o <br /> <br />I LOT# I <br />PARCElID#I"-~6-;J -0010 '-O'J.!;;OO-O.J50 <br /> <br />(OBTAINED FROM PROPERlY TAX NOTICEI <br /> <br />SUBDIVISION <br /> <br />WORK PROPOSED <br /> <br />~ <br />o <br />o <br />lJ;.. ~.J!/'c '-. ., ~ 4 <br /> <br />I SQ FOOTAGE I <br /> <br />SFR <br /> <br />ADD/ALT 0 SIGN D MOVE 0 DEMOLISH <br />REPAIR <br />COMM ~ OTHER I~~II'~ A Ic1.V'''' <br />FRAME 0 STEEL D OTHER I <br />t.'.rt< I/I~ S-y /,.._ /... L(;bhy <br /> I HEIGHT I I <br /> <br />PROPOSED USE <br /> <br />TYPE OF CONSTRUCTION <br /> <br />BLOCK <br /> <br />DESCRIPTION OF WORK <br /> <br />BUILDING SIZE <br /> <br />D BUILDING 1$ I <br />~ ELECTRICAL 1$4000,oD I <br />D PLUMBING 1$ I <br />0 MECHANICAL 1$ I <br />0 GAS D ROOFING 0 <br />FINISHED FLOOR ELEVATIONS I I <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />SPECIALTY D OTHER <br />FLOOD ZONE AREA DYES <br /> <br />DNO <br /> <br />~ <br />D WREC. C) <br /> <br />'<~ <br />S <br />s:-.~ <br />l->-",oe- __ <br /> <br />AMP SERVICE <br /> <br />o <br /> <br />PROGRESS ENERGY <br /> <br />VALUATION OF MECHANICAL INSTALLATION <br /> <br />BUILDER <br />SIGNATURE <br /> <br />COMPANY <br />REGISTERED Y IN FEE CURRENT ~ <br /> license # <br />COMPANY <br />REGISTERED YI N FEE CURRENT ~ <br /> license # <br />COMPANY <br />REGISTERED L..Yl..!::U FEE CURRENT ~ <br /> License # <br /> Y IN FEE CURRENT ~ <br /> License # <br />COMPANY <br />REGISTERED <br /> <br />Address <br /> <br />ELECTRICIAN I <br />SIGNATURE . <br /> <br />Address I <br /> <br />PLUMBER I <br />SIGNATURE <br /> <br />Address I <br /> <br />Address <br /> <br /> <br />MECHANICAL <br />SIGNATURE <br /> <br />OTHER <br />SIGNATURE <br />Address I ~7b) Bz:J,.)"'....;'"'l i~c/}]:... .7" I FL <br />01 <br /> <br />RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms <br />Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Sanitary Facilities & 1 dumpster <br />COMMERCIAL Attach (3) sets of Building Plans; (1) set of Energy Forms. <br />Minimum ten (10) working days after subm~tal date. Required onsite, Construction Plans. Sanitary Facilities & 1 dumpster <br />All commercial requirements must meet compliance. <br />SIGN PERMIT Attach (2) sets of Engineered Plans. <br />"-PROPERTY SURVEY required for all NEW construction. <br /> <br /> <br />Directions: <br />Fill out application completely. <br />Owner & Contractor sign back of application, notarized <br />If ove, $2500, a Notice of Commencement is required. (A/C upgrades over $5000) <br /> <br />Agent (for the contractor) or Power of Attomey (for the owner) would be someone with notarized letter from owner authorizing same <br /> <br />OVER THE COUNTER PERMITTING (Front of Application Only) <br />Reroofs SewersServ ice Upgrades NC Fences (PloVSurvey/Footage) <br /> <br />Driveways-Not over Counter if on public roadways..needs ROW <br />