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<br />Owner's Name <br /> <br />LA.) . Owner Phone Number <br /> <br />I'" d'f 1'f\~ cJ- ~, R..si/.Lown., Phon. Numb., I <br />Ow~~~~ I <br />Owner Phone Number <br />Fee Simple Titleholder Namel tJ A <br /> <br /> <br />t;ity oT Lepnyrnms t-'ermlt ApPIlCaUOn <br />Building Department <br /> <br />rl:lx-o '''-/OV-VV.<:.I <br /> <br />813-780-0020 <br /> <br />DlIte Received <br /> <br />Fee Simple TItleholder Address I tJ! A <br />5(P;L 4- -m C'-C-t c..:t. <br /> <br />~~~ ~tv;> <br /> <br />SUBDIVISION <br /> <br /> <br />LOT # <br /> <br />Iq3 <br /> <br />JOB ADDRESS <br /> <br />WORK PROPOSED <br /> <br />OTHER I <br /> <br />S;~ kr~ <br /> <br />00 <br /> <br />BUILDING <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />D <br />D <br />D <br />D <br /> <br />ELECTRICAL <br /> <br />AMP SERVICE <br /> <br />D <br /> <br />PROGRESS ENERGY <br /> <br />D <br /> <br />W.R.E.C, <br /> <br />PLUMBING <br /> <br />MECHANICAL <br /> <br />VALUATION OF MECHANICAL INSTALLATION <br /> <br />GAS <br /> <br />ROOFING <br /> <br />SPECIALTY D <br />FLOOD ZONE AREA <br /> <br />OTHER <br />DYES <br /> <br />DNO <br /> <br />FINISHED FLOOR ELEVATIONS <br /> <br />BUILDER <br />SIGNATURE <br /> <br /> <br />~~~~+ij;;~~, <br />- .. FEE CURRENT Y I N - <br />License # I <br /> <br /> <br />Y/N <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />COMMERCIAL. <br /> <br />Address 4q~TeJ\son PI. <br /> <br /> <br />ELECTRICIAN I <br />SIGNATURE . <br /> <br />Address I <br /> <br /> <br />PLUMBER I <br />SIGNATURE <br /> <br />Address I <br /> <br /> <br />MECHANICAL I <br />SIGNATURE . <br /> <br />Address ! <br /> <br /> <br />OTHER I <br />SIGNATURE . <br /> <br />Address I I License # <br /> <br />11111111111111111'1 111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111I1I11111 <br /> <br />RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Perm II for new construction, <br />Minimum ten (10) working days after submittal date. Required onslle, Construction Plans, Stormwater Plans wI Slit Fence Installed, <br />Sanitary Facilities & 1 dumpster; Slle Work Permit for subdlvisionsllarge projects <br />Attach (3) sets of Building Plans; (1) set of EnE;lrgy Forms. R-O-W Permit 'tor 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 all new projects. All commercial requirements must meet compliance <br />Attach (2) sets of Engineered Plans. . <br />....PROPERTY SURVEY required for all NEW constructlon. <br /> <br />COMPANY <br />REGISTERED <br /> <br />IY/N <br /> <br />Y I N <br /> <br />FEE CURRENT <br /> <br />License # <br /> <br />COMPANY <br />REGISTERED <br /> <br />YI N <br /> <br />FEE CURRENT <br /> <br />License # <br /> <br />COMPANY <br />REGISTERED <br /> <br />Y I N <br /> <br />FEE CURRENT <br /> <br />Y/N <br /> <br />License # <br /> <br />COMPANY <br />REGISTERED <br /> <br />YI N <br /> <br />FEE CURRENT <br /> <br />I Y IN <br /> <br />SIGN PERMIT <br /> <br />I , . . I . . I . I . . I . I . , . I I . . I . . . . . . . I I ~ I I . . . . . I . . . . , I . I . . . . . I . . I I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . I . . . . . . . I . . . . . . . . . . . . . . . . . , . . . . . . . . . I . I . <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 AlC Fences (PloVSurvey/Footage) <br /> <br />Driveways-Not over Counter If on public roadways..needs ROW <br />