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06/07/2010 22:22 8139621913 PAGE 01 <br /> .. -, ,.. ...... or iHim rtstment <br /> m1lt HpppCetlOfl <br /> Building Depa F ax 813 - 780 -0021 <br /> Date Received <br /> .. -- ".•=ii .-= i•. ..... : :.._,:cc... P hOneContdctforP <br /> Owner's Name II . – Mil <br /> Owner's Address • Owner Phone Number ••- -..- ... <br /> • <br /> Fee Simple Titleholder Name Owner Phone Number <br /> Owner Phone Number E=1=_D <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS <br /> "IllIllIlliIll1111.11""ill"Il0------ . <br /> SUBDIVISION LOT # 1 ------ 1 <br /> PARCEL ID# <br /> WORK PROPOSED (DaTAPNED FROM PROPE TAX NOTICE) <br /> NEW CONSTR ADD /ALT • <br /> INSTALL REPAIR S IGN [ � Mt s'iE n bEMOLISFj <br /> PROPOSED USE • d S FR • <br /> TYPE OF CONSTRUCTION n 1-1 - COMM n OTHER <br /> BLOCK = FRAME • n STEEL n OTHER <br /> DESCRIPTION OF WORK - - � • <br /> BUILDING SIZE I J SO FOOTAGE l • <br /> HEIGHT 1 <br /> = BUILDING 1 I <br /> VALUATION OF TOTAL CONSTRUCTION <br /> J ELECTRICAL AMP SERVICE = PROGRESS ENERGY 1 W.R.E.0 <br /> = PLUMBING � $ <br /> • 1 MECHANICAL I$ VALUATION or MECHANICAL INSTALLATION • <br /> n GAS n ROOFING Q SPECIALTY n OTHER <br /> FINISHED FLOOR ELEVATIONS - f FLOOD ZONE AREA =YES []NO <br /> BUILDER I COMPANY <br /> SIGNATURE I REGISTERED Y/ N FEE CURRENT Y/ N • <br /> Address r _ . • I License # I 1 <br /> ELECTRICIAN ,, COMPANY S Ri " Reg e /ECI CbNStROCt /oi '` • <br /> SIGNATURE ,1 w a a� / d � f REGISTERED ' Y / N FEE CURRENT Y / N <br /> Address 1 1 E P , I5I' hD R 4 $ C ' rc •'Al Fl_3 � ' o1 . License # FC 13O03SJ' ' <br /> PLUMBER COMPANY <br /> I <br /> SIGNATURE . REGISTERED I Y/ N I FEE cuRMENT 1 Y/ N J <br /> Address - I License* <br /> 1 <br /> j • • <br /> MECHANICAL �/� �‘ COMPANY f �/ ./ r K <br /> SIGNATUR - / ` % r; EN <br /> REGISTERED Y / N PEE cuRRT Y / N / © I <br /> Address ' ✓ ' A. , P '1 1, : i _ / /1 3° License # "/ '/ 7h 1 <br /> OTHER COMPANY L • . <br /> SIGNATURE , REGISTERED I Y/ N [ FEE CURRENT I Y/ N I I <br /> • <br /> Address Ucense # [ —1-1 <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 dale. Required onsite, ConsUucdon Plans, Slormwatei Plans w/ Silt Fence installed, <br /> Sanitary Facllllles 8 1 dumpster; Site Work Permit for subdivisions/large projects <br /> COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R -O-W Permit for new construction. <br /> Minimum len (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans wl Silt Fence Installed, <br /> Sanitary Facilities & 1 dumpster. Site Work Permit for all new protects. Aii commercial requirements must meet compliance <br /> SIGN PERMIT Attach (2) sets of Engineered Plane. . <br /> •' SURVEY required for all NEW construction. <br /> Dlrectlons: I <br /> Fill out application completely - <br /> Owner & Contractor sign back of application, notarized <br /> If over $2500, a Notice of Commencement is required.. INC upgrades over $5000) <br /> -- Agent (for the contractor) or Power of Allomey (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 A/C Fences (Plot/Survey/Footage) <br /> • <br /> Driveways -Not over Counter if on public roedways..needs ROW • <br /> • <br /> • <br />