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813-780-0020 City ot Lepnyrnllls ....emlll /'\!-,!-,lIvdLlUII Building Department Date Received Owner Phone Number Owner Phone Number I Owner Phone Number I Owner's Name Owner's Address I~(O Fee Simple Titleholder Namel JOB ADDRESS Fee Simple Titleholder Address I 1-5.2/0 I ( q1:/A. ,pt, t' ~.J- I LOT # PARCEL ID#III- 2ft ~ Zf - 00;0 - 1 ?CjtJ () .~ 0 (J ~O (OBTAINED FROM PROPERTY TAX NOTICE) D., NEW CONSTR ~DD/ALT D SIGN D MOVE D DEMOLISH D INSTALL t::j , REPAIR PROPOSED USE D SFR D COMM D OTHER I TYPE OF CONSTRUCTION D B~ D FRAME D STEEL D DESCRIPTIONOFWORK lX) I k- /Jk- BUILDING SIZE I SQ FOOTAGE I I HEIGHT I II I I II , 11111 III " , I I 11I11 , I 11111 1111 11111 , " 11111111111111111111111111111111111111111111111111111111 , 11111111111111111111111111 ' 111111111111111111 D BUILDING '1$ I ~ ELECTRICAL 1$ I D PLUMBING 1$ I D MECHANICAL 1$ I D GAS D ROOFING D SPECIALTY D OTHER FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO 1111111111111111111111111111111111111111111111,1111111111I111111111111111111111111111111111111111111111111111111I1111111111111111I1111111I111111111 :~~~~~RE I ~~::.: I Y I N FEE CUR""" Y I N I SUBDIVISION WORK PROPOSED OTHER I VALUATION OF TOTAL CONSTRUCTION AMP SERVICE D . PROGRESS ENERGy--E]--.., W.R.E.C. // ,---- \ '//" ~ / it; 07'7 VALUATION OF MECHANICAL INSTALLATION Address ELECTRICIAN SIGNATURE Address PLUMBER SIGNATURE COMPANY REGISTERED Y/N FEE CURRENT Y/N License # COMPANY REGISTERED Y/ N FEE CURRENT Y/N License # COMPANY REGISTERED Y / N FEE CURRENT Y/N SIGN PERMIT Fences (Plot/Survey/Footage) Driveways-Not over Counter If on public roadways..needs ROW