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<br />813-780-0020
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<br />City ot Lepnyrnllls t"ermll J-\~~IIl;C1l1UII
<br />Building Department
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<br />Date Received
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<br />Fee Simple Titleholder Namel
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<br />D PL.UMBING 1$ I
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<br />D MECHANICAL 1$ I
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<br />o GAS 0 ROOFING D SPECIALTY D OTHER
<br />FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO
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<br />BUILDING
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<br />VALUATION OF TOTAL CONSTRUCTION
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<br />AMP SERVICE
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<br />PROGRESS ENERGY
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<br />W.R.E.C.
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<br />VALUATION OF MECHANICAL INSTALLATION
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<br />COMPANY
<br />REGISTERED
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<br />I Y / N I FEE CURRENT
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<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 />COMPANY
<br />REGISTERED
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<br />ELECTRICIAN
<br />SIGNATURE:
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<br />Y/ N FEE CURRENT
<br /> License #
<br />YI N FEE CURRENT
<br /> License #
<br />Y/N FEE CURRENT
<br /> License #
<br />YI N FEE CURRENT
<br /> License #
<br />
<br />Y/N
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<br />Address
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />PLUMBER
<br />SIGNATURE
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<br />Y/N
<br />
<br />Address
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />MECHANICAL
<br />SIGNATURE
<br />
<br />Y/N
<br />
<br />Address
<br />
<br />OTHER
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />Address
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<br />111111111111111 111111111111111111111111111111111111111111111111111111111111111111" 111111111111111111111111111111111111111111111111" 111111111111
<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 subdlvlslons/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 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 />1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 i I11111111111I11
<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 Ale Fences (Plot/Survey/Footage)
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<br />Driveways-Not over Counter if on public roadways..needs ROW
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