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<br />, 813-780-0020
<br />
<br />(.;ity ot Lepnyrnllls ....ermlt AppliCatiOn
<br />Building Department
<br />
<br />. r~J\-OI"-'OV-VV":.1
<br />
<br />Date Received
<br />
<br />
<br />
<br />Owner Phone Number
<br />
<br />~335<1-.:J- I
<br />h . . OWn., PhOne Numb.,
<br />Owner Phone Number I
<br />
<br />WORK PROPOSED
<br />
<br />Owner's Name B (lA.-+z..., ~~
<br />
<br />Owner's Address I 3 <g 3 4-0 ~uJooj PI.
<br />
<br />Fee Slmple'Tltleholder Namel tV I A-
<br />
<br />F.. Slmpl. TlII.hold" Add",.. I '" I A I
<br />
<br />1\.'3'l34-0 Cot~vtCAJao~ Pi, . LOT # .
<br />
<br />~ ~ 0 Z,Dhuf~ I PARCELID#IQ9.'~{P'P?IIO;l181 OOHoo, 0050
<br />.;:; f . -t-tJ. (OOTAl.," FROM PROPERTYT'" """eE,
<br />D NEW CONSTR c:::J ADD/ALT D SIGN D MOVE D DEMOLISH
<br />D INSTALL I..ID.. REPAIR
<br />D SFR r-. COMM D OTHER I '
<br />PROPOSED USE L-I
<br />TYPE OF CONSTRUCTION D BLOCK 0 FRAME D STEEL 0
<br />
<br />DESCRIPTION OF WORK I f<cp/~~ '7 w,';\/dOuJ..I S;?'.lLjL-i....e
<br />
<br />I SQ FOOTAGE HEIGHT I
<br />
<br />JOB ADDRESS
<br />
<br />SUBDIVISION
<br />
<br />OTHER I
<br />
<br />BUILDING SIZE
<br />
<br />BUILDING
<br />
<br />$ ~ S;;?7t OS
<br />
<br />
<br />VALUATION OF TOTAL CONSTRUCTION
<br />
<br />~
<br />
<br />D ELECTRICAL 1$
<br />
<br />D PLUMBING 1$ .
<br />
<br />D MECHANICAL 1$
<br />
<br />o GAS D
<br />FINISHED FLOOR ELEVATIONS
<br />
<br />AMP SERVICE
<br />
<br />D
<br />
<br />PROGRESS ENERGY
<br />
<br />o
<br />
<br />W.R.E.C.
<br />
<br />BUILDER
<br />SIGNATURE
<br />
<br />
<br />ROOFING
<br />
<br />D OTHER
<br />E AREA DYES DNO
<br />
<br />
<br />VALUATION OF MECHANICAL INSTALLATION
<br />
<br />
<br />COMMERCIAL.
<br />
<br />Address 4Gf~ TeJ \sOn
<br />
<br />ELECTRICIAN I
<br />SIGNATURE .
<br />
<br />Address I
<br />
<br />PLUMBER I
<br />SIGNATURE
<br />
<br />Address I
<br />
<br />MECHANICAL I
<br />SIGNATURE .
<br />
<br />Address I
<br />
<br />OTHER I COMPANY
<br />SIGNA TUHE . """ST"'," Y I N I ,.. CURRSNT I Y I N
<br />
<br />Address r '.' . '. "'. I. License #. I . . . . _' I
<br />11111111III11I1 ~ n Iii III 1111111111111 , 111111111111111111111111111111111111111111111111111111111 1111111111111111111 II 111111111111111111 II 11I1111111
<br />RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-Q-W Permit for new construction,
<br />MInimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plalls w/ Silt Fence Installed,
<br />Sanitary Facilities & 1 dumpster; Site Work Permit for subdlvlslons/large projects
<br />Attach (3) sets of Building Plans; (1) set of Enl;lrgy Forms. R-O-W Permlt'for new construction.
<br />Minimum ten (10) working days after submittal date. Required onslte, Construction Plans, Stormwater Plans w/ Slit Fence Installed,
<br />Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance
<br />Attach (2) sets of Engineered Plans. ' .
<br />....PROPE.RTY SURVEY required for all NEW construction.
<br />
<br />~~~~~c,
<br />H _ . _ FEE CURRENT Y I N
<br />
<br />. 11
<br />
<br />License #
<br />
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br /> FEE CURRENT
<br /> License #
<br />Y/ N FEE CURRENT I Y/N
<br /> License #
<br />Y/N FEE CURRENT Y/N
<br /> License #
<br />
<br />I
<br />I
<br />I
<br />:
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />SIGN PERMIT
<br />
<br />, , , , , , '.' , , , , " " " , , , '.' , , , , ,'. , , , p , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ., , , , , " , , . , , , " , , , , , , , , , , , , , . . , , ,', . , , , ,. , , , , , , , , , , , , , , , , . , , , , , . i , , , , , , , , , , , , , , , ,
<br />Directions: ,
<br />Fill out application completely.
<br />Owner & Contractor sIgn back of application, notarized
<br />If over $25(10, 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 />"OVER THE COUNTER PE"RMITTING (Front of Application Only)
<br />Reroofs Sewers Service Upgrades NC Fences (Plot/Survey/Footage)
<br />
<br />Driveways-Not over Counter If on public roadways..needs ROW
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