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<br />813-780-0020 <br />{\ ~~)Y\ <br />G 1J(fPJ'!--f <br />Date Received <br /> <br />GJty or Lepnyrnllls t""ermlI AppllcallUIl <br />Building Department <br /> <br />I ClA-U I v-, UU-UUL. I <br /> <br />'( ZO <br />Owner's Address '--7(0 y 5 (; (eef\ ~ \ 0 p.e Dy <br />Fee Simple Titleholder Namel <br /> <br /> <br /> <br />WORK PROPOSED <br /> <br />ADD/ALT <br />REPAIR <br />COMM <br />FRAME <br /> <br />I <br />I <br /> <br />f:we-, Lo.. I I to:3 : <br />PARCEL ID#I"3L( - z s- - 2 1- OIL( 0 -- 00000-- I &J 30 I <br />(OBTAINED FROM PROPERTY TAX NOTICE) <br />D SIGN 0 MOVE D <br /> <br />D <br />o <br /> <br />Owner Phone Number <br /> <br />Owner Phone Number I <br /> <br />Owner Phone Number I <br /> <br />Owner's Name <br /> <br />SUBDIVISION <br /> <br /> <br />Fee Simple Titleholder Address <br /> <br />JOB ADDRESS <br /> <br />D NEW CONSTR E3 <br />[KI INSTALL <br />PROPOSED USE D SFR D <br />TYPE OF CONSTRUCTION D BLOCK D <br /> <br />DESCRIPTION OF WORK IvV', ()\--.,) \ L \r (lYYLO~€- t -lAf> <br /> <br />I 2 , X l.o '3:> I sa FOOTAGE c:- <br /> <br />O BUILDING 1$ 1yS[:i)O.oo I <br /> <br />o ELECTRICAL ~ DOO.6 c> I <br /> <br />, <br /> <br />o PLUMBING 1$ t; DO CI b I <br />o MECHANICAL 1$. ~ '" I <br />I 06D - ,. <br />, <br /> <br />o GAS D ROOFING D SPECIALTY D OTHER <br />FINISHED FLOOR ELEVATIONS I 1 FLOOD ZONE AREA DYES ONO <br /> <br />~~:~~~~' 'III'~':'"'' "~~"""'"'''''''' '::~~~" i ft'~~~~~~0 Hi ~: ~'''''''''''''''' <br />SIGNATURE - > REGISTERED _' - <br />Address _ _ License # I <br />SELIGENCATTRuICRIEAN~_~ COMPANY 19,{ff~,;~fr9'6{ ~- Ace- <br />=~ REGO"<RED " YI N i FEEeu""'" I Y/N I <br />Address License # I <br />~~.:'A~~E ~ L ~ ~~:'::= I[~i'"y~ te1ef.1c1.~~-I j <br /> <br /> <br />Address === _' - - License # I <br /> <br />MECHANICAL~. .: ~.._ .. ~__. COMPANY I fi}+ :.rfJd:l'WY <br />SIGNATURE ~~ REGISTERED _ Y/ N _ FEE CURRENT <br /> <br />Address License # I <br /> <br />OTHER I <br />SIGNATURE <br /> <br />Address I <br /> <br />DEMOLISH <br /> <br />OTHER IMC'pi\ C <br />STEEL 0 OTHER I <br /> <br />BUILDING SIZE <br /> <br /> <br />HEIGHT I <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />AMP SERVICE <br /> <br />D <br /> <br />PROGRESS ENERGY <br /> <br />o <br /> <br />W.R.E.C <br /> <br />VALUATION OF MECHANICAL INSTALLATION <br /> <br />Y/N <br /> <br />{\Y!:I <br /> <br />COMPANY <br />REGISTERED <br /> <br />Y/N <br /> <br />FEE CURRENT <br /> <br />Y/N <br /> <br />License # <br /> <br />II J 11I111111 J 11111111111 111111111111111 11111111111111 J 111111 11111 11111111 J 1111 III 111111 11111111 1111 III III 111111111111 III 11111111111 11111I111111111 <br />RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permit for new construction, <br />Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence Installed, <br />Sanitary Facilities & 1 dumpster; Site Work Permit for subdlvislons/large projects <br />CpMMERCIAL Attach (3) sets of Building Plans; (1) set of Energy Forms. R-O-W Permit for new construction. <br />Minimum ten (10) working days after submittal date. Required onslte, Construction Plans, Stormwater Plans w/ Slit Fence Installed, <br />Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance <br />SIGN PERMIT Attach (2) sets of Engineered Plans. <br />....PROPERTy SURVEY required for all NEW construction. <br />111111111111111111111111111 J 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 j 1111111111111 i 11111111 <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 Upgrades AlC Fences (Plot/Survey/Footage) <br /> <br />Driveways-Not over Counter If on public roadways..needs ROW <br />