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<br />813-780-002U <br /> <br />"-'I"J -- --r-4J"-.. <br />Building Department <br /> <br />Owner's Name <br /> <br /> <br />(1/LV fA/ Il/, <br /> <br /> <br />. <br />Owner Phone Number <br /> <br />Owner Phone Nu~ber I <br /> <br />Owner Phone Nu~ber I <br /> <br />Date Received <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Namel <br /> <br />F.. S;mF" T,".hold.. Address l <br /> <br />I ~ c <br />1 <br /> <br />JOB ADDRESS <br /> <br />~~ <br /> <br />L!}::.. 5 -1'" <br />) () /, <br /> <br />WORK PROPOSED E:3 <br /> <br />PROPOSED USE 0 <br />TYPE OF CONSTRUCTION 0 <br /> <br />NEW CONSTR <br />INSTALL <br />SFR <br />BLOCK <br /> <br />I <br />.~. <br />o <br />G2f <br /> <br />LOT # <br /> <br />I .O'~ao <br />PARCELlD# ad..- ~(.;,.. "d..l- (JOK-O - 00100 ~ <br />(OBTAINED FROM PROPERTY TAX NOTICE) <br />ADD/ALT D SIGN 0 MOVE D DEMOLISH <br />REPAIR <br />COMM 0 OTHER I <br />FRAME 0 STEEL 0 OTHER I <br /> <br />SUBDIVISION <br /> <br />DESCRIPTION OF WORK lIe ~ .- (( () 0'::: iN rf/ <br />BUILDING SIZE I ] sa FOOTAGE I / ~ g; ! HE:GHT I I <br />I 111111111111111111111111111111111 <br />11111111 " .. I II It 11111111 , " III .. 11 . I ., I ., II II " 1111 t 1111 ,. 111111111 1 111111111111 III 1 111111111 filII III II I , <br /> <br />BUILDING <br /> <br />$ <br /> <br />J-) S tJ, rJo/ <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />D <br /> <br />D <br /> <br />D PLUMBING 1$ I <br /> <br />D MECHANICAL 1$ I VALUATION OF MECHANICAL INSTALLATION <br /> <br />D GAS U2J ROOFING 0 SPECIALTY D OTHER <br />FINISHED FLOOR ELEVATIONS I.. . I FLOOD ZONE AREA DYES DNO . . . <br />1111111111111111111111111111111111111111111111.111111111111111111111111111I11111111111111111I11I1111I111111111111II11111I111111I1111I11111111111111 <br /> <br />COMPANY I I <br />REGISTERED Y I N FEE tURRENT Y / N <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />ELECTRICAL <br /> <br />$ <br /> <br />AMP SERVICE <br /> <br />o <br /> <br />. PROGRESS ENERGY <br /> <br />D <br /> <br />W.R.E.C. <br /> <br />BUILDER <br />SIGNATURE <br /> <br />Address <br /> <br />License # <br /> <br />COMPANY <br />REGISTERED <br /> <br />ELECTRICIAN <br />SIGNATURE <br /> <br />Y/N <br /> <br />FEE CL)RRENT <br /> <br />Y/N <br /> <br />Address <br /> <br />License # <br /> <br />COMPANY <br />REGISTERED <br /> <br />PLUMBER <br />SIGNATURE <br /> <br />Y/ N <br /> <br />FEE CURRENT <br /> <br />Y/N <br /> <br />Address <br /> <br />License # <br /> <br />COMPANY <br />REGISTERED <br /> <br />MECHANICAL <br />SIGNATURE <br /> <br />Y/N <br /> <br />FEE CURRENT <br /> <br />Y/N <br /> <br />Address <br /> <br />License # <br /> <br />~L <br /> <br /> <br />Po to'/- rJCJ fJ/~i ;L-- -:S3S261 License # II2CtJO'l~2t// I <br /> <br />111111111I1111111I111111111111111111111II1I1II1I1111I11IIIIIIIIIIIillllllilllilllllllllllllllillllllllllllll1111111111111'111111111 <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 onslle. 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 onslle, 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 />11111111I1111111I111I1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111I111111111111111111111111111I11 <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 Attorney (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 UP9rades NC <br /> <br />OTHER <br />SIGNATURE <br /> <br />COMPANY <br />REGISTERED <br /> <br /> <br />/2...0 r;/~;fj (j <br />FEE CURRENT <br /> <br /> <br />Address <br />111111111111111 <br />RESIDENTIAL <br /> <br />COMMERCIAL <br /> <br />SIGN PERMIT <br /> <br />Fences (PloUSurvey/Footage) <br /> <br />Driveways-Not over Counter If on public roadways..needs ROW <br />