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<br />813-780-00:lU
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<br />"-'1"'.1 -. --1"'".-.10..--
<br />Building Department
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<br />Date Received
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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 />Owner Phone Number
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<br />Owner Phone Nu~ber l
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<br />Owner Phone NU",ber r
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<br />1 ji.(p'L 1tf
<br />'77tf- J003
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<br />Fee Simple Titleholder Address I
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<br />I s aA'l1k
<br />IDn'..ftwDotL CundiJ s I PARCEL 10#1 0 ~ -:J..(P - ~ J ~ 0;),,1 B - Of() 1-00 - OOhO
<br />~ (OBTAINED FROM PROPERTY TAX NOTICE)
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<br />WORK PROPOSED EJ ~ES~A~~NSTR , 5d' ~~~~~T 0 SIGN D MOVE 0 DEMOLISH
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<br />PROPOSED USE 0 SFR 0 COMM 0 OTHER I
<br />TYPE OF CONSTRUCTION 0 BLOCK 0 FRAME 0 STEEL D OTHER I I
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<br />, 1$ I
<br />1$ I
<br />1$ I
<br />1$ J 1 ? 0 . 00 I
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<br />D GAS 0 ROOFING 0 SPECIALTY D OTHER
<br />FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES [:=JNO
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<br />:~~~~RE I ~~~:;= I Y I N FEE CURRENT Y I N I
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<br />Address I License # I I
<br />11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 i 111I11I111111111111 i 1111111111111111111111 j 11111I11111II
<br />RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms ,
<br />Minimum ten (10) working days after submittal date. Required onsUe. 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 onslte, 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 />11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
<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
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<br />JOB ADDRESS
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<br />SUBDIVISION
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<br />LOT #
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<br />BUILDING
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<br />VALUATION OF TOTAL CONSTRUCTION
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<br />. PROGRESS ENERGY
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<br />D
<br />D.
<br />D
<br />~
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<br />ELECTRICAL
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<br />AMP SERVICE
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<br />PLUMBING
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<br />o
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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 />MECHANICAL
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<br />Address
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<br />ELECTRICIAN I
<br />SIGNATURE .
<br />
<br />Address I
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<br />PLUMBER I
<br />SIGNATURE
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<br />Address I
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<br />COMPANY
<br />REGISTERED
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<br />COMPANY
<br />REGISTERED
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<br />MECHANICAL
<br />SIGNATURE
<br />
<br />
<br />Address
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<br />~
<br />U/.
<br />
<br />OTHER
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
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<br />COMMERCIAL
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<br />SIGN PERMIT
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<br />License #
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<br />Y/N
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<br />Y/N
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<br />FEE CljRRENT
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<br />License #
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<br />Y I N I,
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<br />Y/N
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<br />FEE CURRENT
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<br />License # I
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<br />~i51 /!rIG UJ.,WUJ4A1f
<br />L-1f Y iN I FEE CURRENT . y-IN I .
<br />License # I CAe 0585'75
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<br />Y/N
<br />
<br />Y/N
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<br />FEE CURRENT
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<br />Driveways-Not over Counter If on public roadways..needs ROW
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<br />Fences (PloUSurvey/Footage)
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