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<br />813-780-0020
<br />
<br />
<br />Fax-813-780-0021
<br />
<br />Date Rec~ived
<br />
<br />Fee Simple Titleholder Name
<br />
<br />Owner Phone Number
<br />
<br />Owner Phone Number I
<br />
<br />Owner Phone Number I
<br />
<br />Owner's Name
<br />
<br />Owner.s Address
<br />
<br />Fee Simple Titleholder Address I Sa me a 5 ~..e.,.
<br />
<br />SUBDIVISION
<br />
<br />
<br />PARCEL ID#I
<br />
<br />~ 33::>-z.; 0 LOT # I C:<96
<br />C),t.f-;?h -~-C)()ffd -()(){)~cJ-~
<br />(OBTAINED FROM PROPERTY TAX NOTICE)
<br />SIGN D MOVE D
<br />
<br />JOB ADDRESS
<br />
<br />a
<br />
<br />PROPOSED USE D
<br />
<br />TYPE OF CONSTRUCTION D
<br />
<br />DESCRIPTION OF WORK I ! a f1 tl i
<br />
<br />BUILDING SIZE I I i2. X3;2 I I SQ FOOTAGE I 38' 'I i1 HEIGHT I
<br />TITlT'II'" 11111111" 1111'111'111'1111111"" 11111111' 11111111' 111'1111111111' 11111111111111' 1111" II' '11" 1111111' 1111'1111'11" III" 111'11"111'
<br />
<br />pg::L BUILDING 1$ I VALUATIONOFTOTALCONSTRUCTION/q'ozt::>. 60
<br />
<br />~ ELECTRICAL 1$ I
<br />~ PLUMBING 1$ I
<br />1$ I
<br />
<br />D GAS D ROOFING D SPECIALTY D OTHER
<br />
<br />FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES P\fNO
<br />
<br />IIIIIIIIIIIIIIIIIIIIIII~ IIIJ II ~ IIIIII~ ~ 111111111111111111111111111~1.1t)~11111111111111111111111111111111111111111111111111111111111111111111111,
<br />
<br />BUILDER ~ '\ 't ' COMPANY I Ow /J er' I
<br />SIGNATURE ' .l REGISTERED I Y / N I FEE CURRENT Y / N
<br />
<br />WORK PROPOSED
<br />
<br />NEW CONSTR
<br />INSTALL
<br />SFR
<br />BLOCK
<br />
<br />E3
<br />D
<br />D
<br />
<br />ADD/ALT
<br />REPAIR
<br />COMM
<br />FRAME
<br />
<br />D
<br />D
<br />D
<br />
<br />DEMOLISH
<br />
<br />OTHER
<br />STEEL
<br />
<br />I
<br />D
<br />
<br />OTHER I
<br />
<br />AMP SERVICE
<br />
<br />D
<br />
<br />PROGRESS ENERGY
<br />
<br />~
<br />~/
<br />
<br />WR.E.C,
<br />
<br />D
<br />
<br />MECHANICAL
<br />
<br />VALUATION OF MECHANICAL INSTALLATION
<br />
<br />Address
<br />
<br />
<br />Address
<br />
<br />License #
<br />
<br />ELECTRICIAN
<br />SIGNATURE
<br />
<br />IOf./t?er
<br />~ / N I FEE CURRENT
<br />
<br />Y/N
<br />
<br />Address
<br />
<br />License #
<br />
<br />PLUMBER
<br />SIGNATURE
<br />
<br />I t1w;er
<br />Y / N I FEE CURRENT
<br />License # I
<br />
<br />Y/N
<br />
<br />MECHANICAL
<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 />OTHER
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />FEE CURRENT
<br />
<br />Y/N
<br />
<br />Address License #
<br />
<br />II111II11I111111111I111111111111111111111I11I11111I111II1111II111I111111I111111111111111111I111111I11111111111111I111111111I1111111111111111111I11
<br />
<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 subdivisionsllarge 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 wI 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 />
<br />Dl~~~ti~~~':' , , , , , , , , , . . , , , . , , . , . , , , I . . . , , , , I . . , , . . I . , . . I . , , , . . . , , I . , , , I I , , . , , . . . , , , I I . , , , I . , , . I . I . , , , I , , , , . I I , , . , , , , , . I I , , , , , , , , , . , , , , , , , , , , , , , , , ,
<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 AlC Fences (Plot/Survey/Footage)
<br />
<br />Driveways-Not over Counter if on public roadways..needs ROW
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