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<br />8'13-780-0020 <br /> <br />Owner's Address 1100 <br /> <br />Fee Simple Titleholder Namel <br /> <br />M?i.cVo't Re! /(r,?/}-kok. /VI <br />Grl<- /('\/'./ I ( <br /> <br /> <br />Fax-813-780-0021 <br /> <br />Date Received <br /> <br /> <br />10 -\5--0-7 <br />/( /VCi <br /> <br />Owner's Name <br /> <br />WORK PROPOSED <br /> <br />NEW CONSTR <br />INSTALL <br />SFR <br />BLOCK <br /> <br />I <br />B <br />o <br />D <br /> <br /> <br />Owner Phone Number <br /> <br />IIZ57/ I <br />Owner Phone Number <br /> <br />I Owner Phone Number I <br /> <br />!<. e JI (-.lc>-v- /C rv V <br />I <br /> <br />Fee Simple Titleholder Address I / (/ 0 / t1" .'V'07t.-- <br /> <br />/Zc/ <br />3C//3 7Ov.--;-?4/':"e. [J--z. <br />IE,A--1..,,~a.IJ Po /~/- <br /> <br />~ <br /> <br />PROPOSED USE D <br />TYPE OF CONSTRUCTION D <br /> <br />JOB ADDRESS <br /> <br />SUBDIVISION <br /> <br />ADD/ALT <br />REPAIR <br />COMM <br />FRAME <br /> <br />D <br />D <br />D <br /> <br />OTHER <br />STEEL <br /> <br />I <br />D <br /> <br />SIGN <br /> <br />D <br /> <br />DEMOLISH <br /> <br />OTHER I <br /> <br />DESCRIPTION OF WORK <br /> <br /> <br />I <br /> <br />D BUILDING 1$ S~ t't1:5 t:!f2- <br /> <br />D ELECTRICAL 1$ <br /> <br />D PLUMBING 1$ <br /> <br />D MECHANICAL 1$ <br /> <br />D GAS D <br />FINISHED FLOOR ELEVATIONS I <br /> <br />BUILDING SIZE <br /> <br />ROOFING <br /> <br />I <br />I <br />I <br />I <br />o <br />I <br /> <br />AMP SERVICE <br /> <br />o <br /> <br />PROGRESS ENERGY <br /> <br />D <br /> <br />W.R.E.C, <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />~oc - ~d) <br />~~ ~~- Qu:jd) . <br /> <br />VALUATION OF MECHANICAL INSTALLATION <br /> <br />SPECIALTY D OTHER <br />FLOOD ZONE AREA DYES <br /> <br />~ <br /> <br /> <br />BUILDER <br />SIGNATURE <br /> <br />~t<JlJer <br /> <br /> <br />ELECTRICIAN <br />SIGNATURE <br /> <br />License # <br /> <br /> <br />I f?Lfr~URRENT <br /> <br />,I Y / N <br />/1!~ <br /> <br />PLUMBER <br />SIGNATURE <br /> <br />License # <br /> <br />Q)~ <br />I Y / N FEE CURRENT I Y / N <br />License # I n ~ <br /> <br /> <br />License # <br /> <br />OTHER <br />SIGNATURE <br /> <br />COMPANY <br />REGISTERED <br /> <br />Y/N <br /> <br />FEE CURRENT <br /> <br />Y/N <br /> <br />Address <br /> <br />License # <br /> <br />1111I111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 <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 onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, <br />Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects <br />COMMERCIAL 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 />SIGN PERMIT Attach (2) sets of Engineered Plans. <br />....PROPERTY SURVEY required for all NEW construction. <br />11111111111111111111111111111111111111111111111111111111111I1111111111111111111111111I111111111111111111111111111111111I1111111111111I111111111111 <br />Directions: <br />Fill out application completely. <br />Owner & Contractor sign back of application, notarized <br />If over $2500, 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 NC Fences (Plot/Survey/Footage) <br /> <br />Driveways-Not over Counter if on public roadways..needs ROW <br />