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<br />813-780-0020
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<br />Date Received
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<br />PROPOSED USE
<br />TYPE OF CONSTRUCTION
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<br />ADD/AL T
<br />REPAIR
<br />COMM
<br />FRAME
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<br />:=J LOT# 1237 I
<br />PARCEL 10#1 3LJ -2 $- 2) () \ 70 ..Oet::()O-Z570 I
<br />(OBTAINED FROM PROPERTY TAX NOTICE)
<br />D SIGN 0 MOVE D
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<br />Owner Phone Number
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<br />Owner Phone Number I
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<br />Owner Phone Number L
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<br />Owner's Name
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<br />Owner's Address
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<br />Fee Simple Titleholder Namel
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<br />Fee Simple Titleholder Address
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<br />JOB ADDRESS
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<br />SUBDIVISION
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<br />WORK PROPOSED
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<br />NEW CONSTR
<br />INSTALL
<br />SFR
<br />BLOCK
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<br />DEMOLISH
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<br />DESCRIPTION OF WORK Y\ \)6'\ t. 0 e ~ - Lt.
<br />BUILDING SIZE 12- 7 K <0 0 ISQ FOOTAGE J (p 2 0 HEIGHT I I
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<br />D BUILDING 1$ 35" 006 . r.'> 't I VALUATION OF TOTAL CONSTRUCTION
<br />D ELECTRICAL 1$ I "D()G. "t I AMP SERVICE D PROGRESS ENERGY
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<br />D PLUMBING 1$ 500.00 I
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<br />D MECHANICAL 1$ I 5 DO. ~ () I
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<br />D GAS D ROOFING D
<br />FINISHED FLOOR ELEVATIONS I I
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<br />OTHER Imobilf hGtKO ,
<br />STEEL D OTHER I
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<br />D
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<br />W.R.E.C
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<br />VALUATION OF MECHANICAL INSTALLATiON
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<br />7r--4....Qf.~~
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<br />SPECIALTY D
<br />FLOOD ZONE AREA
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<br />OTHER
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<br />DYES
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<br />C]NO
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<br />I . . I II , II 'It I , I ~ , I I ~ I I II , , I' , I I t I , " I . . I , III It I , I' , I . . H . II " . . I I . I I IIII , " . , . I I I III , , , . I I , I , , II I III , I , I . . , . II " 111111 , II , , , . 1III It I , , , , I " III , , . , .
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<br />I B~ tttyf(eJ d (I/IH -.3 '
<br />I Y I N _ FEE CURRENT
<br />License # I
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<br />BUILDER
<br />SIGNATURE
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<br />Y/N
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<br />Address
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<br />~:c:'~::~~:N~
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<br />
<br />Address _ _
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<br />~~:~~~E !~
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<br />
<br />Address ,
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<br />COMPANY
<br />REGISTERED
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<br />CPffi' ~
<br />Y I N I
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<br />FEE CURRENT
<br />
<br />Y/N
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />License # I
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<br />I~HeI~dd (V\l-Ls
<br />Y I N FEE CURRENT
<br />License # I
<br />
<br />Y/N
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<br />MECHANICAL!~ COMPANY I Beth 15
<br />REGISTERED I Y / N FEE CURRENT Y/N
<br />SIGNATURE ,__> License #
<br />Address
<br />OTHER I COMPANY
<br />SIGNATURE REGISTERED Y I N FEE CURRENT Y/N
<br />Address I License #
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<br />11111111111111111111111111111111111111111111111111111111111II111 1I1II11111 111111111111111111111111111111111111111111111111111111111111111111111111
<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 wi Sill Fence Installed,
<br />Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects
<br />COMMERCIAL 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 onsite, Construction Plans, Stormwater Plans wi Sill 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 />11I11 " III " III " 111I11111111111111 " 11111111111 " III " II " 111111111111 " III " III " 11111I11 " 11111I1111111 " I " 11111 i III i 111111111 fllllllIllllllll
<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)
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<br />Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from oWner authorizing same
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<br />OVER THE COUNTER PERMITTING (Front of Application Only)
<br />Reroofs Sewers Service Upgrades AlC Fences (Plot/Survey/Footage)
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<br />Driveways-Not over Counter If on public roadwaysooneeds ROW
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