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<br />813-780-0020 <br /> <br /> <br />Fax-813-780-0021 <br /> <br />Date Received <br /> <br />Owner's Address <br /> <br />Owner Phone Number <br /> <br />Owner Phone Number I <br /> <br />Owner Phone Number I <br /> <br />Owner's Name <br /> <br />Fee Simple Titleholder Nam <br /> <br />JOB ADDRESS <br /> <br />Fee Simple Titleholder Address <br />'I9SJ- TifitjiF <br /> <br />C ()tJ r f ..s f IL fL /'e <br /> <br />NEW CONSTR <br />INSTALL <br />SFR <br />BLOCK <br /> <br />o <br />I <br />B <br />D <br />D <br />/ <br /> <br /> <br />LOT# I dl <br /> <br />SUBDIVISION <br /> <br />ADD/AL T <br />REPAIR <br />COMM <br />FRAME <br /> <br />(OBTAINED FROM PROPERTY TAX NOTICE) <br />SIGN D MOVE 0 DEMOLISH <br /> <br />WORK PROPOSED <br /> <br />~ <br /> <br />PROPOSED USE D <br />TYPE OF CONSTRUCTION D <br /> <br />/ n IYJ'LAd <br /> <br />BUILDING SIZE I I' I X dJ I I <br /> <br />D <br />D <br />D <br /> <br />OTHER I <br />STEEL D <br /> <br />I <br />I <br /> <br />OTHER I <br /> <br />DESCRIPTION OF WORK <br /> <br /> <br />HEIGHT <br /> <br />ROOFING <br /> <br />I <br />I <br />I <br />I <br />D <br />I <br /> <br />AMP SERVICE <br /> <br />~ <br /> <br />PROGRESS ENERGY <br /> <br />D <br /> <br />W.R.E.C. <br /> <br />~ <br />CjJ <br /> <br />1$ <br /> <br />1$ <br /> <br />1$ <br /> <br />D MECHANICAL 1$ <br /> <br />DGAS D <br />FINISHED FLOOR ELEVATIONS I <br /> <br />BUILDING <br /> <br />rYS,QX).Od <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />ELECTRICAL <br /> <br />PLUMBING <br /> <br />VALUATION OF MECHANICAL INSTALLATION <br /> <br />SPECIALTY D OTHER <br />FLOOD ZONE AREA DYES DNO <br /> <br />Address <br /> <br /> <br />BUILDER <br />SIGNATURE <br /> <br />License # <br /> <br />MECHANICAL <br />SIGNATURE <br /> <br />COMPANY <br />REGISTERED <br /> <br />~~tNe~ ~~~S:~\\8>N ~ <br /> <br />License # I EC.OOO \ 605 . I <br /> <br />C~t31 ~LR~)./f0J7f~ )ftC.~ <br /> <br /> <br />License # I I <br /> <br />I <br />I <br />I <br />I <br /> <br />Y/ N <br /> <br />FEE CURRENT <br /> <br />Y/N <br /> <br />I;I,ECTRICIAN <br />CGNATURE <br /> <br />Address <br /> <br />PLUMBER <br />SIGNATURE <br /> <br />Address <br /> <br />Address <br /> <br />License # <br /> <br />OTHER <br />SIGNATURE <br /> <br />COMPANY <br />REGISTERED <br /> <br />Y/N <br /> <br />FEE CURRENT <br /> <br />Y/N <br /> <br />Address <br />111111111111111 <br />RESIDENTIAL <br /> <br />License # <br /> <br />1""111'1111,1"111111""11111111111111111111111111111""1""1'1'1111111111111111111"""""1111111111111111111111'1"111111 <br /> <br />COMMERCIAL <br /> <br />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 />Attach (3) 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 />All commercial requirements must meet compliance. <br />Attach (2) sets of Engineered Plans. <br />....PROPERTY SURVEY required for all NEW construction, <br /> <br />SIGN PERMIT <br /> <br />I I I I l 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 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 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 I I I I I I I I i <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. (AlC upgrades over $5000) <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 (Front of Application Only) <br />Reroofs Sewers Service Upgrades NC Driveways Fences (Plot/Survey/Footage) <br />