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<br />813-780-0020 <br /> <br /> <br />Fax-813-780-0021 <br /> <br />Date Received <br /> <br />Fee Simple Titleholder Name <br /> <br />Owner Phone Number <br /> <br />wner Phone Number I <br /> <br />Owner Phone Number I <br /> <br />OWner's Name <br /> <br />Owner's Address <br /> <br />JOB ADDRESS <br /> <br />Fee Simple Titleholder Address I Sa VY1 e.. <br /> <br />I 51 r7 & II "6/.;d 'J 7rhtJrhllls. tL 33'5L/:;L LOU I 7.:1,;z. <br />I . I PARCELlD#III-.:<'" - ;)./- COI o-/~tJO- C07D <br />D <br />D <br /> <br />SUBDIVISION <br /> <br />BUILDING SIZE <br /> <br /> <br />NEW CONSTR <br />INSTALL <br />SFR <br />BLOCK <br /> <br />(OBTAINED FROM PROPERTY TAX NOTICE) <br />SIGN D MOVE D <br /> <br />DEMOLISH <br /> <br />WORK PROPOSED <br /> <br />PROPOSED USE <br />TYPE OF CONSTRUCTION <br /> <br />C;ooJ/! .~ <br /> <br />'.....111....,11...............11....11......111..11.....1111..,.......111................,..........11...............111111.111111111..1111.111.. <br /> <br />~ <br /> <br />I I <br /> <br />"1- <br />SQ FOOTAGE I <br /> <br />DESCRIPTION OF WORK <br /> <br />HEIGHT <br /> <br />BUILDING <br /> <br />eo <br /> <br />I <br />I <br />I <br />I <br />D <br /> <br />AMP SERVICE <br /> <br />9G <br /> <br />PROGRESS ENERGY <br /> <br />D <br /> <br />W.R.E.C. <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />D ELECTRICAL <br />D PLUMBING <br />D MECHANICAL <br />D GAS <br /> <br />ROOFING <br /> <br />NOC- _ <br />O"'~ ~'1 OL t-Jl~ <br />VALUATION OF MECHANICAL INSTALLATION ~ <as - O~dc:U:rzd) <br />~CL. Le.n~+tJ I<t<l ~ <br /> <br />~I \-boCll ~tW"';;? (). <SZ> ~ <br />DYES ~NO I eD1 I~-k-t <br /> <br />SPECIALTY D <br />FLOOD ZONE AREA <br /> <br />OTHER <br /> <br />BUILDER <br />SIGNATURE <br /> <br /> <br />Address <br /> <br />I f~ 1 f7 FE1;!ldt;n /1 ~I <br /> <br />License # I 6CC.05CoCo5tf <br /> <br />ELECTRICIAN <br />SIGNATURE <br /> <br />Y I N FEE CURRENT <br /> License # <br />Y I N FEE CURRENT <br /> License # <br />Y/N FEE CURRENT <br /> License # <br />YI 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 />COMPANY <br />REGISTERED <br /> <br />OTHER <br />SIGNATURE <br /> <br />Y/N <br /> <br />Address <br /> <br />111111111111111 11111111111111111I1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 <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 supdivisions/large projects <br />COMMERC'AL 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 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 />1111111111111111111111111111111111111111111111111111111111111111111111111111111111111I11111111111111111111111111111111111111111111I111111111111111 <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) <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 (PloVSurvey/Footage) <br /> <br />Driveways-Not over Counter if on public roadways..needs ROW <br />