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813-780-0020 Date Received Fax-813-780-0021 Cell Owner's Name C'" I Owner Phone Number Owner Phone Number I Owner Phone Number I Owner's Address Fee Simple Titleholder Name WORK PROPOSED Fee Simple Titleholder Address I ~1"1fi) 08U:tM'1(~h~ ;~~ PARCEL ID#I D NEW CONSTR C:=J ADD/AL T D D INSTALL D REPAIR PROPOSED USE D SFR D COMM D TYPE OF CONSTRUCTION D BLOCK D FRAME D 1 (Z-1Zi~ ~l~ (4 1'>\ f 1(> ) BUILDING SIZE I SQ FOOTAGE HEIGHT I 111111111111111111111111111"'111111'111111111111111""'111111111111111111111111111111'11111111111111111'"IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIT JOB ADDRESS LOT # SUBDIVISION (OBTAINED FROM PROPERTY TAX NOTICE) SIGN D MOVE D DEMOLISH OTHER I STEEL D OTHER I DESCRIPTION OF WORK D BUILDING ~ I I I I D GAS D ROOFING D SPECIALTY D OTHER FINISHEDFLOORELEVATIONS I I FLOOD ZONE AREA DYES DNO\J~~~~~~~G .p-'\- ! D-\~' 111I111111111111I111111111111111111111111111111111111111111'111111111111111111111111111111 U 11111111111111111111111111111'lln~IITllllllllllllll D ELECTRICAL 1$ 1$ I $ ~ tlJlJl) - 1$ VALUATION OF TOTAL CONSTRUCTION PLUMBING D 3f4 (I 3<w--\~~ ~ VALUATION OF MECHANICAL INSTALLATION to.~ p'-(m+- c>p. J"\ _ J,.) CdY1 (Y"I0::::\-1 <.t.f) ,~' ~ p~ AMP SERVICE PROGRESS ENERGY D W.REC. D MECHANICAL I I I I I I I I I I BUILDER SIGNATURE COMPANY REGISTERED Y/N FEE CURRENT License # Y/N FEE CURRENT License # Y/N FEE CURRENT License # Y/N FEE CURRENT Y/N Address ELECTRICIAN SIGNATURE COMPANY REGISTERED Y/N Address PLUMBER SIGNATURE COMPANY REGISTERED Y/N Address MECHANICAL SIGNATURE COMPANY REGISTERED Y/N COMMERCIAL Address ~ I OTHER \ COMPANY I ~~~ Svr.~e..'2- SIGNATURE - r-- )..-- R'",STEREO ~ I "" CURRm {l...VN I Address I-;v~" -ftru....~t1ln fA.. ~t() ~. ~H~ License # ~,~V 1111111111111I111111111111111111111 , 111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 " , " , " RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permit for new construction, Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects Attach (3) sets of Building Plans; (1) set of Energy Forms. R-O-W Permit for new construction, Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans wI Silt Fence installed, Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance Attach (2) sets of Engineered Plans, ....PROPERTY SURVEY required for all NEW construction. License # SIGN PERMIT Di~~~ti~~~.: . . . 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 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 . . . Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement is required. (A1C 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-Not over Counter if on public roadwaysuneeds ROW Fem,e, (PIOtlSU"'eY'F~~" ",., .. , ' ' ,- ,. I "',,~-~';:::;'.-, . .M" .~. ~..' . -. '. , })d/)i 1..f.. _;'u.-.i -:.-'h.'" '".I ~."t \.,,::tOli,/j "'\:"'~' . '~~';~'f;.;~ . JE". ., ..'?' . ~.. " ........ ~" ':" ~,_:~, '~..'