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<br />813-780-0020 <br /> <br />Fax-813-780-0021 <br /> <br />NEW CONSTR c>ZI ADD/AL T D <br />INSTALL D REPAIR <br />PROPOSED USE SFR D COMM D OTHER <br />TYPE OF CONSTRUCTION D BLOCK D FRAME D STEEL D <br /> <br />SUleh Vl~ / ('com j;zvJdr e-Y-fstJ1j earp"rt <br /> <br />BUILDING SIZE I I SQFOOTAGEI dJ6 ___ HEIGHT I I <br /> <br />...11....11..........11...111..11.......111....1111..............1.11...111.......11....11....111.............111'..11.........................11. <br /> <br />D BUILDING 1$ Lf& {)O eE. I <br /> <br />D ELECTRICAL 1$ I <br /> <br />D PLUMBING 1$ I <br /> <br />D MECHANICAL 1$ I <br /> <br />D GAS D ROOFING D SPECIALTY D OTHER <br />FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES ~NO <br /> <br />11111111111111111"""111111111"""'1"""""""""'111'1"'1"""""5.~1"""""1"""""":"""11""'11111111111111"111111111 <br /> <br />BUILDER - A /J. _ . /J .' 4~~PANY I BtLh r ts Ii} U rr71 n l.-VYYl I <br />SIGNATURE ~a/.....; REGISTERED VYJ/ N I FEE CURRENT r-y / N I <br /> <br />License # I (!. 6 C l1 ~ 077 <br /> <br /> <br />Date Received <br /> <br />a J, ~ I) r Owner Phone Number <br /> <br />fMG; ~f~;;:p. hon'Numbo,1 <br /> <br />Owner Phone Number I <br /> <br />Owner's Name <br /> <br />SUBDIVISION <br /> <br />I S H- 3 3sz-1~ <br />{} :< - ;2.~ - ;;;Lf- 06/ C- {)tJ d 6~-O;(s-D <br /> <br />LOT # <br /> <br />I <br />I <br />I <br />1;;?5 I <br />I <br /> <br />Fee Simple Titleholder Address <br /> <br />JOB ADDRESS <br /> <br />WORK PROPOSED <br /> <br />(OBTAINED FROM PROPERTY TAX NOTICE) <br />SIGN D MOVE D <br /> <br />DEMOLISH <br /> <br />OTHER I <br /> <br />DESCRIPTION OF WORK <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />AMP SERVICE <br /> <br />~ <br /> <br />PROGRESS ENERGY <br /> <br />D <br /> <br />W.R.E.C. <br /> <br />~C)C- <br /> <br />VALUATION OF MECHANICAL INSTALLATION <br /> <br />Address <br /> <br />b tj/j{) wf <br /> <br /> <br />ELECTRICIAN <br />SIGNATURE <br /> <br />COMPANY <br />REGISTERED <br /> <br />Y/N FEE CURRENT <br /> License # <br />Y/ N FEE CURRENT <br /> License # <br />Y/N FEE CURRENT <br /> License # <br />Y / N FEE CURRENT <br /> License # <br /> <br />Y/N <br /> <br />Address <br /> <br />PLUMBER <br />SIGNATURE <br /> <br />COMPANY <br />REGISTERED <br /> <br />Y/N <br /> <br />Address <br /> <br />MECHANICAL <br />SIGNATURE <br /> <br />COMPANY <br />REGISTERED <br /> <br />Y/N <br /> <br />Address <br /> <br />OTHER <br />SIGNATURE <br /> <br />COMPANY <br />REGISTERED <br /> <br />Y/N <br /> <br />Address <br /> <br />111I11111111111 111I111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111I11111111111111111111 <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 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 w/ Silt 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 />1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 i 111111111111111111 i 11111111 <br />Directions: <br />Fill out application completely. 5~ _ <br />Owner & Contractor sign back of application, notarized 27, ':> - <br />If over $2500, a Notice of Commencement is required. (AlC upgrades over $5000) l -. '> -J <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 NC Fences (Plot/Survey/Footage) <br /> <br />Driveways-Not over Counter if on public roadways..needs ROW <br />