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<br />813-780-0020 <br /> <br />City ot Lepnyrnllls t"'ernllll"'\IJIJlllidllUII <br />Building Department <br /> <br />Date Received <br /> <br /> <br />-;2.~-O <br />;g AliI<. <br />6' r 5r <br /> <br /> <br />Owner Phone Number <br /> <br />Owner Phone Number I <br /> <br />Owner Phone Number I <br /> <br />Owner's Name <br /> <br />Owner's Address I ~ /'5 <br />Fee Simple Titleholder Namel <br /> <br />2-1-t1 U.f <br /> <br />Fee Simple Titleholder Address <br /> <br />JOB ADDRESS <br /> <br />s-~ / 3 8T'^ ~T <br /> <br />'2 ~ l-tt lA./ <br /> <br />LOT # <br /> <br />I <br /> <br /> <br />E3 NEW CONSTR c=J <br />INSTALL . Cl <br /> <br />PROPOSED USE D SFR 0 <br /> <br />TYPE OF CONSTRUCTION D BLOCK 0 <br /> <br />DESCRIPTION OF WORK I $""0 <:. U f6~(~ <br /> <br />BUILDING SIZE I I SQ FOOTAGE I I HEIGHT I <br />, II rill' I1II II I 11111 I , I II1I , II II , , IIII , 111111111111111111111111111 1 111111111111111111 . 11111111111111 r 111111111111 , III , I III , III t . 111111111111 r 11111 <br /> <br />D BUILDING 1$ I <br /> <br /> <br />D ELECTRICAL 1$ I <br /> <br />D PLUMBING 1$ I <br /> <br />D MECHANICAL 1$ I <br /> <br />D GAS D ROOFING 0 SPECIALTY D OTHER <br />FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO <br />11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111I1111I11I111111111 <br /> <br />:~~~~RE I I ;."::.~ I y / N FEE CUI""", Y / N I <br />Address I ~ """"eO I <br /> <br /> <br />ELECTRICIAN. .. c-:% COMPANY f20 () 6'l..S' "6 L'- <.. I <br />SIGNATURE . REGISTERED I Y I N I FEE CURRENT Y IN <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br /> <br /> <br />Address I License # I I <br /> <br />11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 i 11111I111111111111111111111111111111111111111I11111111II <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 />Attach (3) sets of Building Plans; (1) set of Energy Forms. <br />Minimum ten (10) working days after submittal date. Required onslte, 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 />111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111I1111 <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 /> <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 Sewers Service Upgrades AlC <br /> <br />1\ 1- Z~ -21-00j() -0 "'OtJ-D07 0 <br />PARCEL 10# <br />(OBTAINED FROM PROPERTY TAX NOTICE) <br />SIGN D MOVE D <br /> <br />SUBDIVISION <br /> <br />WORK PROPOSED <br /> <br />ADD/ALT <br />REPAiR <br />COMM <br />FRAME <br /> <br />D <br />D <br />D <br /> <br />DEMOLISH <br /> <br />OTHER LOS V e.. <br />STEEL D <br /> <br />U~6fl11PC <br />OTHER I <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />VALUATION OF MECHANICAL INSTALLATION <br /> <br /> <br />DW:RJ;:,.C. <br />/>> --~ <br /> <br />;( ~ I?-ct <br /> <br />, <br />, <br /> <br />AMP SERVICE <br /> <br />o <br /> <br />. PROGRESS ENERGY <br /> <br /> <br />Address <br /> <br />License # <br /> <br />PLUMBER <br />SIGNATURE <br /> <br />COMPANY <br />REGISTERED <br /> <br />Y/ N <br /> <br />FEE CURRENT <br /> <br />Y/N <br /> <br />Address <br /> <br />License # <br /> <br />MECHANICAL <br />SIGNATURE <br /> <br />COMPANY <br />REGISTERED <br /> <br />Y/ N <br /> <br />FEE CURRENT <br /> <br />Y/N <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 />COMMERCIAL <br /> <br />SIGN PERMIT <br /> <br />Fences (Plot/Survey/Footage) <br /> <br />Driveways-Not over Counter If on public roadways..needs ROW <br />