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813-780-0020 City at Lepnyrmlls t'ernlll !-\jJjJlI\jdUUII Building Department Owner's Name Owner's Address I Y'75 '-f Fee Simple Titleholder Namel Owner Phone Number Owner Phone Number I 7 7Cf - 41 S-O Owner Phone Number I Date Received 5+ Fee Simple Titleholder Address I I I o NEWCONSTR r=J ADD/ALT D INSTALL D REPAIR PROPOSED USE 0 SFR 0 COMM TYPE OF CONSTRUCTION 0 BLOCK 0 FRAME DESCRIPTION OF WORK I wood ~ V'...\fl fno12Clc..y I I. I I b ,] BUILDING SIZE I I SQ FOOTAGE q, ' HEIGHT TIT' 1'1' I111I111I 11111111' 111111111'1111111' II 1111' 11111111111111 III 11111111111'11111': I11I 11111111111111111 '11'1' 1111'1'111' I "111111 '111111111 II D BUILDING 1$ IS-OO.oO I D ELECTRICAL 1$ I D PLUMBING 1$ I D MECHANICAL 1$ I D GAS 0 ROOFING 0 FINISHED FLOOR ELEVATIONS I I 1111111111111111" ",?"lJ1""""""""""""""""""" i ".""".""""""",""""""""""'I'~"'""""""""""""', BUILDER /I ~ COMPANY AC;VI e (,M)( 1-"'" " t'l . /ll? SIGNATURE ,r-t L ~. REGISTERED Y I N FEE CURRENT Y I N Address -5-6 10 " tJ 51 License # I 31 g [ PARCEL ID#I I j~ -Ab-).I-OO/O--02hOO -0/40 (OBTAINED FROM PROPERTY TAX NOTICE) SIGN 0 MOVE 0 LOT # JOB ADDRESS ~o..-. (. SUBDIVISION WORK PROPOSED o o o DEMOLISH OTHER I STEEL 0 OTHER I VALUATION OF TOTAL CONSTRUCTION AMP SERVICE o PROGRESS ENERGY o W.R.E.C. VALUATION OF MECHANICAL INSTALLATION SPECIALTY 0 FLOOD ZONE AREA OTHER DYES ONO SIGN PERMIT I I I I I I I I Address I License # I I 11111111I111111111111111111111111111111I111111111111111IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIilllilllllllllllllllillllllllllllllllllllllllllllllllllll RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms Minimum ten (10) working days after submittal date. Required onslte. Construction Plans. Sanitary Facilities & 1 dumpster Attach (3) 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 All commercial requirements must meet compliance. Attach (2) sets of Engineered Plans. ....PROPERTY SURVEY required for all NEW construction. 11111111111111111111111111111I11111111111I111111111111111111111111111111111111111111111111111111111111111111111111111111111111111I1111111111111111 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 NC ELECTRICIAN SIGNATURE COMPANY REGISTERED Y/N FEE CURRENT Y/N Address License # COMPANY REGISTERED PLUMBER SIGNATURE Y/N FEE CURRENT Y/N Address License # COMPANY REGISTERED MECHANICAL SIGNATURE Y/N FEE CURRENT Y/N Address License # COMPANY REGISTERED OTHER SIGNATURE Y/N FEE CURRENT Y/N COMMERCIAL Fences (PloUSurvey/Footage) Driveways-Not over Counter If on public roadways..needs ROW