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<br />813-780-0020 <br /> <br />C:ity ot Lepnyrnllfs ~ermlt AppllCa1l0n <br />Building Department <br /> <br />, r-C1J\-O Iv-fOV-VV'<:,1 <br /> <br />Date Received <br /> <br /> <br />Owner Phone Number <br /> <br />wner Phone Number I <br />Fl 34-ItJO,=, I <br />Owner Phone Number <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br /> <br />Fee Simple Titleholder Address ~1 A <br /> <br />JOB ADDRESS <br /> <br />14--~ A <br />I <br /> <br /> <br />Cl/lt 6 Gsm <br /> <br />PARCELlD# 34--~5. ~I-D/(ol} 00000, DOlO <br />(OBTAINED FROM PROPERTY TAX NOTICE) <br />SIGN D MOVE D <br /> <br />DEMOLISH <br /> <br />o...tt ~l vel , <br /> <br />I <br /> <br />D NEW CONSTR cstJ ADD/All D <br />D INSTALL !Z:SI REPAIR <br />PROPOSED USE D SFR D COMM D OTHER <br />TYPE OF CONSTRUCTION 0 BLOCK D FRAME 0 STEEL D OTHER I, , <br /> <br />DESCRIPTION OF WORK ~ fW a.Q4/Lkr. F '/ cul..d- 3 ~ .fl::hch'(}Yt..Il/ <br /> <br />BUILDING SIZE I I SQ FOOTAGE I I HEIGHT I ' "I <br /> <br />11111; IIII'~~I~~:~~III"I'III~ I"'I"III'II'I'IIII"'I"'IIIIII~~~~'~~;~'~'~~I~~~~~'~~~~~~~~~I~~I"IIII"I"'I' 1111111111111111111111111,11 <br /> <br />o ELECTRICAL 1$ I AMP SERVICE 0 PROGRESS ENERGY D W,R,E,C, <br />t-.JDC. <br />D PLUMBING 1$ I <br /> <br />o MECHANICAL 1$ I VALUATION OF MECHANICAL INSTALLATION M <br /> <br />o GAS D ROOFING D SPECiAlTY M OTHER Fi~~OO.OO <br />FINISHED FLOOR ELEVATIONS I I FLOOD ZON~A DYES DNO <br /> <br />SUBDIVISION <br /> <br />WORK PROPOSED <br /> <br />BUILDER <br />SIGNATUR~ <br />FIRE/"" <br />Address <br /> <br /> <br /> <br />License # <br /> <br />IEFOOot~11 <br /> <br />COMPANY <br />REGISTERED <br /> <br />Y IN <br /> <br />FEE CURRENT <br /> <br />Y/N <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />ELECTRICIAN <br />SIGNATURE <br /> <br />Address <br /> <br />License # <br /> <br />/JIlt- <br /> <br />PLUMBER <br />SIGNATURE <br /> <br />COMPANY <br />REGISTERED <br /> <br />Address I <br /> <br />MECHANICAL <br />SIGNATURE , <br /> <br />Address I <br /> <br />OTHER I <br />SIGNATURE <br /> <br />Address I I License # <br />II J 1I1111111 J III filii 11111 II III 11111 11111 1I111 1111I 11111 11111 11111 III I J I111111111111111I11 J 11111I111111111111111I1111111111111111111111111I111111I <br />RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permit for new construction, <br />Minimum ten (10) working days after submittal date, Required onslte, Construction Plans, Stormwater Plans w/ Silt Fence Installed, <br />Sanitary Facllltles & 1 dumpster; Site Work Permit for subdlvislonsllarge projects <br />Attach (3) sets of BUilding Plans; (1) set of Energy Forms. R-O-W Permit'for new construction. <br />Minimum ten (10) working days after submittal date, Required onsite. Construction Plans, Stormwater Plans w/ Silt 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 />....PROPERTy SURVEY required for all NEW construction. <br /> <br />,....,.........\...".............................,.......,.....,................................................,....,."....................."1 <br />Directions: , <br />Fill out application completely. <br />Owner & Contractor sign back of application, notarized <br />If over $25()0, 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 /> <br />OVER THE COUNTER PERMITTING (Front of Application Only) <br />Reroofs Sewers Senflce Upgrades AlC <br /> <br />Y/N <br /> <br />FEE CURRENT <br /> <br />Y/N <br /> <br />~/A- <br /> <br />License # <br /> <br />COMPANY <br />REGISTERED <br /> <br />YI N <br /> <br />FEE CURRENT <br /> <br />Y/N <br /> <br />tJ/;r <br /> <br />License # <br /> <br />COMPANY <br />REGISTERED <br /> <br />Y/N <br /> <br />FEE CURRENT <br /> <br />Y/N <br /> <br />COMMERCIAL, <br /> <br />SIGN PERMIT <br /> <br />Fences (Plot/SurveY/Footage) <br /> <br />Driveways-Not over Counter If on public roadways..needs ROW <br />