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813-780-0020 (;Ity OT Lepnyrmlls t"emlll MJJJJII\jdLlUII Building Department Date Received Owner's Address ~ 7 ~ C> Fee Simple Titleholder Nam~ /2/k 5'17l~ , Owner phone Num er Y Owner phone Number I ~7G 1'., ,.?tJ y' -6~ '1J7 OWner Phone Number I Owner's Name Fee Simple Titleholder Address LOT # JOB ADDRESS PARCEL ID#I (OBTAINED FROM PROPERTY TAX NOTICE) SIGN 0 MOVE 0 DEMOLISH WORK PROPOSED NEW CONSTR INSTALL SFR BLOCK I B' o o ADD/ALT REPAIR COMM FRAME o o o SUBDIVISION ~.. B PROPOSED USE 0 TYPE OF CONSTRUCTION 0 DESCRIPTION OF WORK I BU'LDING SIZE 1 ~ ~: I SQ FOOTAGE L _ Z qP... .. .. . ..I.. . ..~~.~':;'. .I.. " .. .. " " " " .. " .. ) , " . " , " .. " " .. " , " , .. . III.. I I. I.. I. II.. "_ _~_.. I--=: II... I. II.. II. I..... II III.... "_- --....... --.... o BUILDING 1$ VALUATION OF TOTAL CONSTRUCTION 1$ o PLUMBING 1$ o MECHANICAL 1$ o GAS 0 FINISHED FLOOR ELEVATIONS I OTHER STEEL I o OTHER I I I I ELECTRICAL AMP SERVICE t! rtJ .~ PROGRESS ENERGY I/fG~er I~(J ~ o W.R.E.C. ~ VALUATION OF MECHANICAL INSTALLATION ROOFING o I SPECIALTY 0 FLOOD ZONE AREA OTHER DYES DNO I , . , I I . . I I I , , . I I I I I I . . . . . I . I . I . I I ~ I I I I I I I . . . pI. . . . . I I . . I I . I . . . I I . I . I . . I . . . I I I . . . , , I I I . . I I . . I . . I I I . . I . I . . I . I I I . . . I I I I I I . I I . I . . I . I . I . . I I I . I . . I I . . I . I BUILDER SIGNATURE COMPANY REGISTERED Y/N Address Address ELECTRICIAN SIGNATURE License # Y I N FEE CURRENT License # Y/N FEE CURRENT License # Y IN FEE CURRENT License # PLUMBER SIGNATURE COMPANY REGISTERED Y/N Address COMPANY REGISTERED MECHANICAL SIGNATURE Y/N Address COMPANY REGISTERED OTHER SIGNATURE Y/N Address II" , . IIII , I . I "111"1111'" 1IIII t 11I1I11I1111111111111 , II , I11I , 11I11 ~ 11III1 , I , , , , 111I111I1 , 111111111111111. III , I I , , , 1111 , III r I1I11 , 111111111111 , RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Sanitary Facilities & 1 dumpster COMMERCIAL Attach (3) sets of Building Plans; (1) liet of Energy Forms. Minimum ten (10) working days after submittal date. Required onslte, Construction Plans, Sanitary Facilities & 1 dumpster All commercial requirements must meet compliance. SIGN PERMIT Attach (2) sets of Engineered Plans. ....PROPERTY SURVEY required for all NEW construction. j 1111111. 111111111111. ~ j 111111 j 111111. I . . ~ j ~ II. j 1111111-1. . 11111 ~ j I1111 ~ . . . I1111111111I111 i 111111. 11111I111 i ~ 1111 i I i I ~ ~ ~ 1111 i 1111I111 i II i i II ~ 1111 i i DIrections: Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement Is required. (AlC upgrades over $5000) ** Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs Sewers Service Upgrades AlC Driveways Fences (PloUSurvey/Footage)