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<br />813-780-0020
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<br />City of Zepnyrn,"s t-'ermlI APfJlI(ji::lllUII
<br />Building Department
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<br />/ 7 T/!
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<br />
<br />Date Receiived
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<br />OWner's Name
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<br />Owner's Address 16 6 ~
<br />Fee Simphl Titleholder Namel
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<br />Fee Slmplll Titleholder Address
<br />I <:; A-- 1--/1 F'
<br />I
<br />
<br />1$ ff'66~ 6 <0 I
<br />1$ I
<br />1$ I
<br />1$ I
<br />
<br />
<br />
<br />D GAS D ROOFING D SPECIALTY D OTHER
<br />
<br />
<br />FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO
<br />
<br />
<br />
<br />t , . . . I I I I I I I , I I I I I . . . . , I I , I , , , , , . , . , I , I I , . I I . , , , , I t II , , I , II , . . . I . III , , , I , , , I 111 r I I , . . I , , . I I I II I , , , , , . . I , , , . , ~ I I I I . I , I . . I III , , I I I II I , II , , , t I I . , . II ,
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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 />PROPOSED USE
<br />TYPE OF CONSTRUCTION
<br />
<br />DESCRIPTION OF WORK
<br />
<br />D ElUILDING
<br />D ELECTRICAL
<br />D PLUMBING
<br />D MECHANICAL
<br />
<br />()cDZ
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<br />.----
<br />51
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<br />Owner Phone Number
<br />OWner Phone Number I
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<br />Owner Phone Number I
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<br />LOT #
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<br />PARCELID#IC)'a-~<.o. ~\ ~ O\~ - 60000 - 650<::>
<br />(OBTAINED FROM PROPERTY TAX NOTICE)
<br />ADD/ALT D SIGN D MOVE D DEMOLISH
<br />REPAIR
<br />COMM D
<br />FRAME D
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<br />;::-IZQ~
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<br />B
<br />D
<br />D
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<br />NEW CONSTR
<br />INSTALL
<br />SFR
<br />BLOCK
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<br />OTHER I
<br />STEEL D
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<br />R 0 ()h-
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<br />OTHER I
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<br />VALUATION OF TOTAL CONSTRUCTION
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<br />AMP SERVICE
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<br />D
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<br />o
<br />
<br />W.R.E.C,
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<br />PROGRESS ENERGY
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<br />VALUATION OF MECHANICAL INSTALLATION
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<br />BUILDER
<br />SIGNATURE
<br />
<br />11:/Md
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />;5)w;V~
<br />FEE CURRENT . Y I N
<br />
<br />Address
<br />
<br />License #
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<br />ELECTRICIAN
<br />SIGfiATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />Y/N FEE CURRENT
<br /> License #
<br />YI N FEE CURRENT
<br /> License #
<br />Y/N FEE CURRENT
<br /> License #
<br />YIN FEE CURRENT
<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 License #
<br />1I111111111I11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
<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 Silt Fence installed,
<br />Sanitary Facilities & 1 dumpster; Site Work Permit for subdivlsionsllarge projects .
<br />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 onsile, 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 />Attach (2) sets of Engineered Plans.
<br />....PROPERTY SURVEY required for all NEW construction.
<br />111I111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 i i 11111111111111111111111111 i 11111111111111111 i 111I1111
<br />Directions:
<br />Fill out ;~pplication 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
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<br />OVER THE COUNTER PERMITTING (Front of Application Only)
<br />Reroofs Sewers Service Upgrades NC
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<br />COMMERCIAL
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<br />SIGN PERMIT
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<br />Driveways-Not over Counter if on public roadways..needs ROW
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<br />Fences (Plot/Survey/Footage)
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