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<br />813-780-0020
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<br />
<br />Owner Phone Number
<br />
<br />~aer Phone Number I
<br />Owner Phone Number I
<br />
<br />Date Received
<br />
<br />Owner's Name
<br />
<br />J L,
<br />
<br />() R -h
<br />
<br />jam as bc...ve-
<br />
<br />Fee Simple Titleholder Address I 5~-f a C;; cc-h6TYe!.-
<br />
<br />(Pf}{) F(. -facC--h ti? 5f.
<br />
<br />'rDifh.rM Phase.1Y-)
<br />
<br />c=:Y NEW CONSTR n ADD/ALT
<br />[J2J INSTALL D REPAIR
<br />PROPOSED USE D SFR 0 COMM OTHER
<br />TYPE OF CONSTRUCTION D BLOCK D FRAME D STEEL D
<br />
<br />DESCRIPTION OF WORK Ill--dd IItn:Jl kJmdo~( -/7; ~j{lsh i 6W&17 c~
<br />
<br />BUILDING SIZE I SQ FOOTAGE _ _ HEIGHT I
<br />0"" I ~~:~~;~~ I" I I" I I i~ I 'j 2 ~5' ~" I' '~: I I I I ~~~~~:~~'~; ~~~~~ '~~~~~~;,~~' I I 1'1'" I ""'" I I I"'" "....""'.'" I I
<br />
<br />D ELECTRICAL 1$ I AMP SERVICE ~ PROGRESS ENERGY 0 WRE.C
<br />
<br />D PLUMBING 1$ I
<br />D MECHANICAL 1$ I
<br />
<br />D GAS D ROOFING D
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<br />Fee Simple Titleholder Name
<br />
<br />Owner's Address
<br />
<br />SUBDIVISION
<br />
<br />
<br />LOT #
<br />
<br />1/
<br />
<br />JOB ADDRESS
<br />
<br />MID
<br />
<br />WORK PROPOSED
<br />
<br />SIGN
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<br />DEMOLISH
<br />
<br />OTHER I
<br />
<br />VALUATION OF MECHANICAL INSTALLATION
<br />
<br />FINISHED FLOOR ELEVATIONS
<br />
<br />SPECIAL TV D
<br />FLOOD ZONE AREA
<br />
<br />OTHER
<br />
<br />DYES
<br />
<br />~NO
<br />
<br />Address
<br />
<br />
<br />
<br />BUILDER
<br />SIGNATURE
<br />
<br />I~~ f/~~~J~ I
<br />License # I (!j3 C /J;I, ~ D77
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<br />ELECTRICIAN
<br />SIGNATURE
<br />
<br />Y/N FEE CURRENT
<br /> License #
<br />YI N FEE CURRENT
<br /> License #
<br />YI N FEE CURRENT
<br /> License #
<br />Y/N FEE CURRENT
<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 />SIGN PERMIT
<br />
<br />License #
<br />11111111111111111111111111111I111I111111111111111111111111I111111111111I1111111111111111111111111111111111111111111111111111111111
<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 wI 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 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 />DI~~~ti~~~':' , , . . . . , , . . . , , , , , , . . . . , . . . . , , , . . . , , , . . , , , . . , , . . . , , , . . . . . . . , , , . . , , , . . , , , , . . . . . . . . . , . . . . , , , . . . . . . , . , , , . . . . . , , , , , . . . , . . , , . , , . , , , , . . , , , , , , ,
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<br />Fill out application completely.
<br />Owner & Contractor sign back of application, notarized
<br />If over $2500. a Notice of Commencement is required. (A1C 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
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<br />OVER THE COUNTER PERMITTING (Front of Application Only)
<br />Reroofs Sewers Service Upgrades AlC Fences (PloUSurvey/Footage)
<br />
<br />Address
<br />111111111111111
<br />RESIDENTIAL
<br />
<br />COMMERCIAL
<br />
<br />Driveways-Not over Counter if on public roadways..needs ROW
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