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<br />813-780-0020
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<br />
<br />Fax-813-780-0021
<br />
<br />Date Received
<br />
<br />JOB ADDRESS
<br />
<br />Owner's Name Dt. ris 7Z ~ r OttM
<br />Ownef.Add.... 137~A5 ~hm 1k~/~E}~e'Ph.n.Numb.,1
<br />
<br />Fee Simple Titleholder Name St::t e as ak I Owner Phone Number I
<br />
<br />Fee Simple Titleholder Address.' :sa m e..- tl 5 ~YR-
<br />
<br />r62t) AI~J71 M, ~,Ih, fi- 3354 ( I LOU I F/.:{
<br />
<br />I ~ran-:i I-!rJ r iUnS I PARCEL ID#/YL.f-eE" -~;- tJOtftJ-!JtJtJdtf- 1'1 c2CJ
<br />. (OBTAINED FROM PROPERTY TAX NOTICE)
<br />NEW CONSTR c=J ADD/ALT D SIGN D MOVE D
<br />INSTALL D REPAIR
<br />SFR D COMM D
<br />BLOCK D FRAME D
<br />
<br />I / W, Yldovu5
<br />
<br />SUBDIVISION
<br />
<br />WORK PROPOSED
<br />
<br />
<br />DEMOLISH
<br />
<br />PROPOSED USE
<br />TYPE OF CONSTRUCTION
<br />
<br />OTHER
<br />STEEL
<br />
<br />I
<br />D
<br />
<br />OTHER I
<br />
<br />BUILDING SIZE
<br />
<br />I ~
<br />SQ FOOTAGE I
<br />
<br />HEIGHT I
<br />
<br />D
<br />
<br />"11111"11111111111'111'1"""111""11'1"1111'11111"tllllll""II,II"'II""IIIIIIIIIIIII,IIIIII'IIII'111111111"fllllllllllllllllll"'11111
<br />
<br />BUILDING
<br />
<br />I $ If S-() (J!!!2.
<br />1$
<br />
<br />1$
<br />
<br />1$
<br />D GAS D
<br />FINISHED FLOOR ELEVATIONS I
<br />
<br />ELECTRICAL
<br />
<br />VALUATION OF TOTAL CONSTRUCTION
<br />AMP SERVICE ~ PROGRESS ENERGY
<br />
<br />D
<br />
<br />W.R.E.C,
<br />
<br />D
<br />D
<br />D
<br />
<br />PLUMBING
<br />
<br />MECHANICAL
<br />
<br />VALUATION OF MECHANICAL INSTALLATION
<br />
<br />~
<br />
<br />Address
<br />
<br />
<br />ROOFING
<br />
<br />OTHER
<br />
<br />DYES
<br />
<br />
<br />BUILDER
<br />SIGNATURE
<br />
<br />l~tf~~~-lhp-19N I
<br />
<br />License # ICBctld'6017
<br />
<br />ELECTRICIAN
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N FEE CURRENT
<br /> License #
<br />Y/N FEE CURRENT
<br /> License #
<br />Y/N FEE CURRENT
<br /> License #
<br />Y/N 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 />I
<br />
<br />Address
<br />
<br />PLUMBER
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />Address
<br />
<br />MECHANICAL
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />Address
<br />
<br />OTHER
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />License #
<br />1111111111I111I111111111111I111111111111111111111II11111I111I1I11111111111111111111111111111111111111111I1111I11111111II11111I11I1
<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 onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed,
<br />Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large 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 />Di~~~ti~~~': ' , , , , . , , , , , , . , . , , , , , . , . , , , . . , , , . . , , , , . , , . . . , . . , , , , . . , , , . . , , , , , . . , , , , . , , , , , , , , , . . . . , , , , , , , , . , , , , . . , , . , . , , , , , , , . , , , , . . . . . , . , . , , , , , , , , . . , ,
<br />
<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 />Address
<br />111111111111111
<br />RESIDENTIAL
<br />
<br />COMMERCIAL
<br />
<br />SIGN PERMIT
<br />
<br />Driveways-Not over Counter if on public roadways..needs ROW
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