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<br />Ei13-780-0020 .
<br />
<br />City ot Lepnyrnllls t-"ermlt AppliCatiOn
<br />Building Department
<br />
<br />rCiX-O I v-I OU-UU",I
<br />
<br />Fee Slmple'Tltleholder Name
<br />
<br />
<br />Owner Phone Number
<br />
<br />Fl- :33540 I
<br />Owner Phone Number
<br />I
<br />
<br />Owner Phone Number I
<br />
<br />Date Received
<br />
<br />Owner's Name
<br />
<br />Owner's Address
<br />
<br />WORK PROPOSED
<br />
<br />Fee Simple Titleholder Address I N I k
<br />
<br />3<6003 UU"hJen A\J'.e.
<br />
<br />
<br />lALpha Vi \ \ CljC- ~s-hde-s I
<br />
<br />
<br />D NEW CONSTR c:=J
<br />D INSTALL ~
<br />
<br />PROPOSED USE D SFR D
<br />
<br />TYPE OF CONSTRUCTION 0 BLOCK D
<br />
<br />DESCRIPTION OF WORK I !2e-PIA"L I PA-ii'O
<br />
<br />BUILDING SIZE I I SQ FOOTAGE I I HEIGHT I ,
<br />111111111111. II , II , I , , , 111111 ,., , 11 , 111111' , 1 , IT. , , II , II , , , . , I , r 1I11 , . . , I , 11 , 11I1II1111I1 till' , r, II 111I , , r r 111I11 , , I " 1111 r r II P II , , 11I1111 , ,., . r 11I1
<br />
<br />I
<br />I
<br />I
<br />I
<br />D
<br />
<br />SUBDIVISION
<br />
<br />'Z-e hI. V ~ I 1):5 fL. 335Lft
<br />
<br />PARCELlD# 35-~5.~ 1 f ()()SA I 00000, 1/30
<br />iOBTAINED FROM PROPERTY TAX NOTICE)
<br />SIGN 0 MOVE D
<br />
<br />Lot #
<br />
<br />JOB ADDRESS
<br />
<br />AD DIAL T
<br />REPAIR
<br />COMM
<br />FRAME
<br />
<br />o
<br />D
<br />D
<br />S 1,'d~,e.
<br />
<br />DEMOLISH
<br />
<br />OTHER I
<br />STEEL D OTHER I
<br />
<br />S/2e /s;~
<br />.
<br />
<br />!Xl
<br />o
<br />o
<br />o
<br />o
<br />
<br />BUiLDiNG
<br />
<br />1$
<br />1$
<br />1$
<br />1$
<br />D
<br />
<br />AMP SERVICE
<br />
<br />D
<br />
<br />PROGRESS ENERGY
<br />
<br />D
<br />
<br />W.R.E.C.
<br />
<br />gIO.<67
<br />
<br />VALUATION OF TOTAL CONSTRUCTION
<br />
<br />ELECTRiCAL
<br />
<br />PLUMBING
<br />
<br />GAS
<br />
<br />ROOFING
<br />
<br />SPECIALTY D
<br />
<br />FLOOD ZONE AREA
<br />
<br />OTHER
<br />
<br />",\lL\~o'1
<br />C);V\ ~
<br />6~~)jr
<br />
<br />MECHANiCAL
<br />
<br />VALUATION OF MECHANICAL INSTALLATION
<br />
<br />FINISHED FLOOR ELEVATIONS
<br />
<br />
<br />DYES
<br />
<br />DNO
<br />
<br />BUILDER
<br />SIGNATURE
<br />
<br />Address 14cl~ Tel \scm PI. Oda..hclO, FL. "6 ~ ~I.;l.
<br />
<br />ELECTRICIAN I COMPANY
<br />SIGNATURE , REGISTERED Y I N FEE CURRENT Y I N
<br />
<br />Address I License #
<br />
<br />PLUMBER: I COMPANY
<br />SIGNATURE , REGISTERED Y I N FEE CURRENT Y I N
<br />
<br />Address I LIcense #
<br />
<br />MECHANICAL I COMPANY
<br />SIGNATURE REGISTERED Y I N FEE CURRENT Y I N
<br />
<br />Address I License #
<br />
<br />OTHER I COMPANY
<br />SIGNATURE REGISTERED Y I N FEE CURRENT I' Y I N
<br />
<br />Address I License # I
<br />11111I1111I11111 n 1111I111111111I11111111111111111111I1111111II111111111111111111111111111111111111111111111111111 I 111111111111 II! 11111111I111I1I1
<br />
<br />RESIDENTIAL
<br />
<br />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 wI Slit Fence Installed,
<br />Sanitary Facilities & 1 dumpster; Site Work Permit for subdivlslonsllarge projects
<br />Attach (3) sets of Building Plans; (1) set of En~rgy Forms. R-O-W Permit tor new construction.
<br />Minimum ten (10) working days after submittal date. Required onslte, Construction Plans, Stormwater Plans wI 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 />COMMERCIAL
<br />
<br />SIGN PERMIT
<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 Service Upgrades AlC Fences (PloUSurvey/Footage)
<br />
<br />nft___..._ ""_a. _~___ _____. ._
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