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813-780-0020 City of Lepnyrmlls t"errTIIl I'\J-IJ-I"lJdllUII Building Department Date Received flfu~u<. / J -- S rt(Y1 P ,<.--r ->. Owner's Address I/O~~.1. IV f:1t.i Y'1/1$~ II(.;)~ N{].~J 1~"JftI'A:ft.. Fee Simple Titleholder Namel -- Owner's Name ;~~ I '-- Owner Phone Nu~ber (~l' OWner Phone Number I Owner Phone Number I Fee Simple Titleholder Address LOT # ~ SUBDIVISION c.j{ &-Sy lJ I fiA) Hlusl ""PARCEL ID#I -- JOB ADDRESS WORK PROPOSED B o o El o o ADD/ALT 0 REPAIR COMM 0 FRAME 0 NEW CONSTR INSTALL SFR BLOCK PROPOSED USE TYPE OF CONSTRUCTION ---- DESCRIPTION OF WORK :}:.N S T I'tL l. ,,j c)'F SQ FOOTAGE I I I IIII II 1 1111111 , 11111 I III , I I , IIII , III " III , , , 111111 . III I 111111 ., III 11111 11111 11111 lilT 11111 TlIIIIIIIIIIIIII , . II " . I , I 1 , . II . III II , , . 1111111111111111 1$ I 1$ I 1$ I D MECHANICAL 1$ I D GAS 0 ROOFING 0 SPECIALTY 0 OTHER FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO 11111111111111111111111111111111111111111I11I11111111111I111111111111111111111111111111111111111111111111111111I11111111111111111I111111111I111111 I I I I I I I I I I License # I I 1111111111111111111111111111111111111111111111111111111IIIIIIIIIIIIIIIIIIilllillllllllllllllllllllllllllllll1IIIIIIIilllllllUIIII Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms _ Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Sanitary Facilities & 1 dumpster Attach (3) sets of Building Plans; (1) set of Energy Forms. Minimum ten (10) working days after submittal date. Required onslte, Construction Plans, Sanitary Facilities & 1 dumpster All commercial requirements must meet compliance, Attach (2) sets of Engineered Plans. ***~PROPERTY SURVEY required for all NEW construction. II.IIII!IIIIIIIIII.IIIIIIIIIIIIIIIIIIIIIIIIIIIII.IIIII111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 Directions: Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement Is required. (AlC upgrades over $5000) .* Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs Sewers Service Upgrades AlC BUILDING SIZE D D (OBTAINED FROM PROPERTY TAX NOTICE) SIGN 0 MOVE 0 DEMOLISH OTHER I STEEL 0 OTHER I ,.j fM<' C<;IVlJ'l () I~J / r HEIGHT I G"N--f(-?.-JC e:. ELECTRICAL AMP SERVICE VALUATION OF TOTAL CONSTRUCTION o PROGRESS ENERGY /e:J ,/ W.R.E.C. BUILDING - 0 PLUMBING ID~ VALUATION OF MECHANICAL INSTALLATION BUILDER SIGNATURE COMPANY REGISTERED Address ELECTRICIAN I SIGNATURE COMPANY REGISTERED Address -.. PLUMBER SIGNATURE vt'< ;I( L~ COMPANY REGISTERED Address MECHANICAL SIGNATURE COMPANY REGISTERED Address OTHER SIGNATURE COMPANY REGISTERED Address 111111111111111 RESIDENTIAL COMMERCIAL SIGN PERMIT Y/N Y/N FEE CURRENT License # Y/N Y/N FEE CURRENT License # flq 'I yY) () '^ j t: itJ-rr: ~ /f'( 15 E- j " . Y I N I FEE CURRENT I Y / N I License # I /#c. YI N FEE CURRENT Y/N License # Y/N Y/N FEE CURRENT Driveways-Not over Counter If on public roadways..needs ROW Fences (PloUSurvey/Footage)