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<br />813-760-~020 <br /> <br />City ot Lepnyrnllls t"ernlll J-\fJfJlIl;dllUII <br />Building Department <br /> <br />Date Received <br /> <br /> <br /> <br />q-lt.\-O~ <br />y~ 'l/S/& ~ WL- <br />./ OWn.(, Add...., I 3'1 ,1.".u/-".tJr- <br />Fee Simple Tltleh~lder Name <br /> <br />/ Owner's Name <br /> <br /> <br />/ <br />Phone Contact for Permlttln <br /> <br />c, <br />7-rMY4 R: 131'9~ <br /> <br />Owner Phone Number <br /> <br />Owner Phone Number I <br /> <br />Fee Simple Titleh~lder Address I <br /> <br />I ~7~9 ~kd'~ <br />I <br /> <br />E3 <br />D <br />D <br />I ~Mh..M:-.f &~L~ 1":: S;b> <br /> <br />I SQ FOOTAGE _ , . 3' _ s <br /> <br />/ JOB ADDRESS I <br />I <br />SUBDIVISION I <br /> <br />WORK PROPOSE~ <br />i <br />I <br /> <br />NEW CONSTR <br />INSTALL <br />SFR <br />BLOCK <br /> <br />PROPOSED USE <br />TYPE OF CONST~CTION <br /> <br />/ DESCRIPTION OF <br /> <br /> <br />BUILDING SIZE <br /> <br />~/.,;-~~ .Ft!- 5~S/f2- <br />I PAR~L1D#1 <br /> <br />LOT# <br /> <br />B <br />D <br />D <br /> <br />D <br />D <br />D <br /> <br />(OBTAINED FROM PROPERTY TAX NOTICE) <br />SIGN 0 MOVE D <br /> <br />DEMOLISH <br /> <br />ADD/ALT <br />REPAIR <br />COMM <br />FRAME <br /> <br />OTHER I <br />STEEL 0 <br /> <br />OTHER I <br /> <br />i Ddt~ <br />HEIGHT I <br /> <br /> <br />'1$ <br />. \ \ \ I D 00, (:) 0 <br /> <br />1$ <br /> <br />1$ <br /> <br />1$ <br /> <br />D ROOFING <br /> <br />D <br /> <br />D <br /> <br />D PLUMBI~G <br /> <br />D MECHA1CAL <br /> <br />D GAS <br />FINISHED FLOOR <br /> <br />BUILDER <br />/ SIGNATURE <br /> <br />~";r\ <br /> <br />Address <br /> <br />ELECTRICIAN <br />SIGNATURE <br /> <br />Address <br /> <br />PLUMBER <br />SIGNATURE <br /> <br />Address <br /> <br />MECHANICAL <br />SIGNATURE <br /> <br />Address <br /> <br />OTHER <br />SIGNATURE <br /> <br />Address <br /> <br />I <br />I <br />I <br />I <br />D <br />I <br /> <br />V,8LUATION OJ: TOTAL CONSTRUCTION <br />~\ll )6\o.~) <br />AMP SERVICE D PROGRESS ENERGY <br /> <br />D <br /> <br />W.R.E.C. <br /> <br />f0bL <br /> <br />\~. <br /> <br />VALUATION OF MECHANICAL INSTALLATION <br /> <br />SPECIALTY D OTHER <br />FLOOD ZONE AREA DYES <br /> <br />VE~ -to PIJ}S'1II'1J6f<, <br />DNO <br /> <br /> <br />sr. 'C.~OMPA~EllI ~M.t1 D"-,, ,.;<; . - ~tv <br />REGISTERED Y I . FEE CURRENT. I Y IN) I - ~ 'r/ <br />3 "3:5\4 0 License # I . ~D. 6fJ <br />, . <br /> <br />: r <br />I <br />I <br />I <br />I <br />I <br />I <br />I <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 />License # <br /> <br />COMPANY <br />REGISTERED <br /> <br />YI N <br /> <br />FEE CURRENT <br /> <br />Y/N <br /> <br /> <br />License # <br /> <br />Y/N <br /> <br />FEE CURRENT <br /> <br />Y/N <br /> <br />License # <br /> <br />RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms . <br />Minimum ten (10) working days after submittal date. Required onslte, Construction Plans, Sanitary Facilities & 1 dumpster <br />COMMERCIAL Attach (3) sets of BUilding Plans; (1) set of Energy Forms. <br />~inimum ten (10) working days after submittal date. Required onsite, Construction Plans, Sanitary Facilities & 1 dumpster <br />II commercial requirements must meet compliance. <br />SIGN PERMIT Attach (2) sets of Engineered Plans. <br />!...~PROPERTY SURVEY required for all NEW construction. <br />lllll'! I1I11I1111I1 n 111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111I1I11111I11 <br />Directions: <br />Fill out applicati n completely. <br />Owner & Contra tor sign back of application, notarized <br />If over $2500, a otice of Commencement is required. (AlC upgrades over $5000) <br /> <br />Agent (for the co tractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authOrizing same <br /> <br />OVER THE COUNTE PERMITTING (Front of Application Only) <br />Reroofs ewers Service Upgrades AlC Fences (PloUSurvey/Footage) <br /> <br />Driveways-Not ver Counter If on public roadways..needs ROW <br />