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<br />\oJ1"J -- --,......J..--- - .
<br />Building Department" II S CC
<br />,t\o I
<br />
<br />phone Contact for Permitting ~S')..-
<br />
<br />813-780-002U
<br />
<br />Date Received
<br />
<br />
<br />Owner's Name
<br />
<br />,Me-
<br />
<br />Owner's Address
<br />
<br />Fee Simple Titleholder Name[
<br />
<br />~V?s
<br />
<br />
<br />
<br />,
<br />Owner Phone Number
<br />
<br />OWne, phone Nu~be' i
<br />Owner Phone Number
<br />
<br />Fee Simple Titleholder Address 1-
<br />
<br />r 3~l~i 5~ Me-
<br />lL~~eh~
<br />
<br />8 NEW CONSTR 8
<br />INSTALL '
<br />
<br />PROPOSED USE 0 SFR 0
<br />TYPE OF CONSTRUCTION 0 BLOCK 0
<br />
<br />_ftI- ~
<br />DESCRIPTION OF WORK \k ~ 1 ,
<br />
<br />~,~~~~,'~~,~~. , , , .I. ,~ ~: , ~. f.if. ~, :, !. . , , ,~~ ~~~~~~~ ~, :. ~ ,f. ,~. " . , , · , ;: "., ~~~~~~, ,I, ~, .~, :, , , · , · ., , · , , J · · , · · "" , , , · , , , · , , · "
<br />o BUILDING '1$ b ~ ' z:ro VALUATION OF TOTAL CONSTRUCTION
<br />o . ELECTRICAL 1$
<br />
<br />o PLUMBING 1$
<br />
<br />D MECHANICAL 1$
<br />
<br />D GAS 0 ROOFING 0 SPECIALTY 0 OTHER
<br />FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO
<br />111I111111111 I 111111111111111111111111111111111111 II 1I11I111111 ; I II 11111111111111111111111111111111 II 11111111111111111111111I1I11I111II11111111I11
<br />I
<br />I
<br />:
<br />I
<br />I
<br />I
<br />
<br />LOT #
<br />
<br />l LI-2..lr ~/-tJf)ID -/5g{)O, -,0 (00
<br />PARCEL 10#
<br />(OBTAINED FROM PROPERTY TAX NOTICE)
<br />ADD/All ~ SIGN 0 MOVE 0 DEMOLISH
<br />REPAIR
<br />COMM
<br />FRAME
<br />
<br />JOB ADDRESS
<br />
<br />SUBDIVISION
<br />
<br />WORK PROPOSED
<br />
<br />
<br />;7() AMP SERVICE
<br />
<br />o
<br />o
<br />
<br />I
<br />o
<br />
<br />OTHER
<br />STEEL
<br />
<br />OTHER I
<br />
<br />
<br />o
<br />
<br />, PROGRESS ENERGY
<br />
<br />o
<br />
<br />W.R.E.C.
<br />
<br />NO c. -
<br />i\~" I-~ p/u -
<br />
<br />VALUATION OF MECHANICAL INSTALLATION
<br />
<br />COMPANY
<br />REGISTERED Y Y N
<br />
<br />J.ei'II~;I=~'III~'~'11 ~';';.~:'~~';'IIIIII'I ~~ 11111~:;~ilr'IIIII~~,~~.z'IIIII,1
<br />
<br />Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms
<br />Minimum ten (10) working days after submittal date. Required onsite. 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 onslle. 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 />11.l111!1111111111111111111111111111111111111111111111111I111I1II111111111111111111111111I1111111111111I1111I11111111I111111I1111111I11111111I11111
<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
<br />
<br />BUILDER
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Address
<br />
<br />ELECTRICIAN
<br />SIGNATURE
<br />
<br />'~
<br />
<br />35 L ~o I
<br />~~ Il.At l.{l.
<br />I
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Address
<br />
<br />"'701
<br />
<br />~, kn"\.u;J I).J ~
<br />
<br />PLUMBER
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Address
<br />
<br />MECHANICAL
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Address
<br />
<br />OTHER
<br />SIGNATURE
<br />
<br />~ ~5_~
<br />
<br />Address
<br />111111111111111
<br />RESIDENTIAL
<br />
<br />COMMERCIAL
<br />
<br />SIGN PERMIT
<br />
<br />Y/N
<br />
<br />FEE CURRENT
<br />
<br />Y/N
<br />
<br />License # I
<br />
<br />c<fa;r I ~~I~RRE~ 6YN I
<br />
<br />License # IE~bO~D t.fJ,7
<br />
<br />Y/N
<br />
<br />FEE CURRENT
<br />
<br />Y/N
<br />
<br />License #
<br />
<br />YI N
<br />
<br />FEE CURRENT
<br />
<br />Y/N
<br />
<br />
<br />Driveways-Not over Counter If on public roadways..needs ROW
<br />
<br />Fences (PloUSurvey/Footage)
<br />
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