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<br />813-780-0020 <br /> <br />City of zepnyrmlls t"emlll /"\l-'l-'lIva~lvll <br />Building Department <br /> <br />Date Receiv.ed <br /> <br /> <br />^' ~ <br />OWner"s Name .. "" "'~, ,\ ' <br />Owner'sAddress I ~~D\ 0'~\w-~\~\~ M <br /> <br />F.. Simp" T;..hold" N~ <br /> <br />Fee Simple Titleholder Addre~s ~ , . ." <br />JOB ADDRESS I ~ ') ~~1'-\o\ <br /> <br />Owner Phone Number <br />Owner Phone Number I n \ '"3 <br />Owner Phone Number I <br /> <br />SUBDIVISION <br /> <br />(~~\ -~\ ~. . I LOT# I <br />I PARCELID#l ~y -J0--2t~ooouOO~-~O <br />(OBTAINED FROM PROPERTY TAX NOTICE) <br />o NEW CONSTR 8 ADD/ALT 0 SIGN D MOVE 0 <br />D INSTALL REPAIR <br />PROPOSED USE 0 SFR 0 COMM 0 OTHER I <br />TYPE OF CONSTRUCTION 0 BLOCK 0 FRAME 0 STEEL D OTHER I <br /> <br />DESCRIPllON OF WORK 1\<2- ''^--0 ~"E', '-~ (t', ~"" L... P ~-<... ~ <br /> <br />BUILDING SIZE I ISQ FOOTAGE I I HEIGHT I <br /> <br />,.......................................,.........................................................\..............................,................ <br /> <br />DEMOLISH <br /> <br />WORK PROPOSED <br /> <br />0 BUILDING <br />0 ELECTRICAL <br />0 PLUMBING <br />0 MECHANICAL <br /> <br />1$ I <br />1$ I <br />1$ I <br />1$ I <br /> <br />o GAS 0 ROOFING 0 SPECIALTY 0 OTHER <br />FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO <br /> <br />~~;;;;;;~~,."""""."~~~~::~":,.""""""."""'i.~~~;:;:~~~~~~..,.,...".."'i <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />AMP SERVICE <br /> <br />o <br /> <br />PROGRESS ENERGY <br /> <br />D <br /> <br />W.R.E.C. <br /> <br />VALUATION OF MECHANICAL INSTALLATION <br /> <br /> <br />OTHER <br />SIGNATURE <br /> <br />Y/N <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br /> <br /> License # <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 />ELECTRICIAN <br />SIG~ATURE <br /> <br />COMPANY <br />REGISTERED <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 />COMPANY <br />REGISTERED <br /> <br />MECHANICAL <br />SIGNATURE <br /> <br />Y/N <br /> <br />Address <br /> <br />COMPANY <br />REGISTERED <br /> <br />Address <br /> <br />11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 <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 onsile, 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 />11.11111111111111111111111111111111111111111111111111111IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIllllllillllllllllllllll11111111I1I11111111111I111111111111I11 <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 Ale Fences (PloUSurvey/Footage) <br /> <br />Driveways-Not over Counter if on public roadways..needs ROW <br />