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<br />813-780-0020 <br /> <br /> <br />Fax-813-780-Q021 <br /> <br />0aIIe Received <br /> <br />WORK PROPOSED <br /> <br />. -.z-l) <br />Owner's Name Ih f 6- ~ /' LTo <br />Owner'sAddl1lss ~6 t If) 7~ ke. ~~3f /r("t;JVYL" J.skl.~ ~erPhoneNumber I~DD......$f~ -.if?I! I <br /> <br />F.. Simple TllIeholder Name I ,iI. I It- <br /> <br />..........,........--. [ ~....I I 4/'-'_ I) <br />JOB ADDRESS ~DOq l.I l-IuJ~.3 0; /2 '.f J.,'.1r~' /h, FL I LOT. I <br /> <br />I I PARCELID#I b3-2ird -oOlD-II(;JC:(J-CO,/-/ <br />R ~. :::-D~":';':DD O<MO"," <br />~ ~ <br /> <br />Owner Phone Number I <br /> <br />SUBDIVISION <br /> <br />PROPOSED USE <br />TYPE OF CONSTRUCTION <br /> <br /> <br />J <br />1 <br /> <br />SIC <br /> <br />DESCRIPTION OF WORK <br /> <br />~ <br />~ <br /> <br />1 <br />1$ 5FJJ/J6 <br /> <br />1$ ..i/dJJ,(';;y1<,MP SERVICE <br /> <br />D PLUMBING 1$ 1 <br /> <br />D MECHANiCAl 1$ 1 <br /> <br />D GAS D ROOFING CJ <br />FINISHED FLOOR ELEVATIONS I I <br /> <br />BUILDING <br />st~'i'"" <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />BUILDING SIZE <br /> <br />ELECTRICAL <br /> <br />CJ <br /> <br />PROGRESS ENERGY <br /> <br />D <br /> <br />WREC. <br /> <br />VALUATION OF MECHANiCAl INSTALLATION <br /> <br />SPECIALTY D <br />FLOOD ZONE AREA <br /> <br />OTHER <br />DYES <br /> <br />DNO <br /> <br />I CO"'ANY <br />REGISTERED Lri.!:U FEE CURRENT L.:L!lU <br />~.o~: License # <br />I ~ <br />YI N FEE CURRENT <br /> License # <br />I CO"'ANY <br />REGISTERED Y/N FEE CURRENT ~ <br /> License # <br /> <br />BUILDER <br />SIGNATURE <br /> <br />Addl1lss i <br />ELECTRICIAN <br />SIGNATURE <br /> <br />Addl1lss . <br /> <br />PLU_ER I <br />SIGNATURE <br /> <br />Address I <br /> <br />Addl1lss <br /> <br /> <br />I <br />REGISTERED Lri.!:U Lice:: :URR1ENT <br />I ~ J/e~~E~ ~ <br />License # I iES DC'(Yl(\ 7 :5 <br /> <br />L.:L!lU <br /> <br />MECHANICAL <br />SIGNATURE <br /> <br />OTHER <br />SIGNATURE <br /> <br />Addl1lss <br /> <br />RESIDENTIAL <br /> <br />Attach (2) lot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permit for new construction, <br />Minimu en (10) working days after submittal date. Required onsrte, Construction Plans, Stormwater Plans wi Silt Fence installed, <br />Sanita Facilities & 1 dumpster, Site Work Permrt for subdivisions/large projects <br />Attach 3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Fonns. R-D-W Permrt for new construction. <br />Minim ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans wi Silt Fence installed, <br />Sanitary Facilities & 1 dumpster. Srte 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 PERMT <br /> <br />IlII <br />DIrections: <br />Fill out application completely. <br />Owner & Contractor sign back of application, notarized <br />If over $2500, a Notice of Commencement is I1lquired. lAIC upgrades over $5000) <br /> <br />Agent (for the contractor) or PClINer of Attorney (for the owner) lMluld be someone IMth notarized letter from owner authorizing same <br /> <br />OVER THE COUNTER PERMITTING (Front of Application Only) <br />Reroofs SeINers Service Upgrades AlC Fences (PlotlSurveylFootage) <br />Driveways-Not over Counter if on public roadways..needs ROW <br /> <br />fImmmt: <br />