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813- 780 -0020 Gity of Lepnyrnms r ettltJt /1p1JII..QuuIi �� Building Department ' ) D Date Received Tl� d-,) /•- /0 Phone Contact for Permitting 1A.? Ark -- ` -3/5 1111111111111t Owner's Name v fin/ W /'t " [�� 1-09/2 Owner Phone Number Owner's Address I a1 fY7 C/ -" I Owner Phone Number I I Fee Simple Titleholder Namel Owner Phone Number 1 Fee Simple Titleholder Address ( JOB ADDRESS 3196 `t 1 L04 i LOT # ALI SUBDIVISION /4cfE'�Y'u= AL4+ PARCEL ID #I pki (08TAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR I I ADD /ALT � I SIGN 1 MOVE I I DEMOLISH INSTALL J REPAIR PROPOSED USE I I SFR I I COMM I I OTHER I I TYPE OF CONSTRUCTION 1 1 BLOCK I I // FRAME I 1 STEEL I I OTHER I I DESCRIPTION OF WORK Ca-7 IIrT O' BUILDING SIZE 1 r ` Y 37 r SQ FOOTAGE 571 HEIGHT BUILDING $ // MO. !P VALUATION OF TOTAL CONSTRUCTION li W I I ELECTRICAL $ AMP SERVICE I I PROGRESS ENERGY I I W.R.E.C. Wad I I PLUMBING $ /(,b---_ PASCO PERMITSERV '� (813) 78$.5314 I I MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION FAX 1-866-824.78g4 1 1 GAS 1 I ROOFING 1 1 SPECIALTY I I OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA 1 IYES 1 INO BUILDER r��ff �, ' J I3 Q 0S-° COMPANY � J44 /IOW ` - SIGNATURE i< 1641 ' REGISTERED I Y / N I FEE CURRENT I Y / N I Address I S Y r0,* ""'7 ,ed ti f"' A' J3 License # ELECTRICIAN COMPANY SIGNATURE REGISTERED I Y / N I FEE CURRENT I Y / N I Address License # PLUMBER COMPANY SIGNATURE REGISTERED I Y / N I FEE CURRENT I Y/ N I Address License # r MECHANICAL COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y / N I Address License # OTHER COMPANY SIGNATURE REGISTERED I Y / N I FEE CURRENT I Y/ N I Address License # r RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R -O -W Permit for new construction, Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions /large projects 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. Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance SIGN PERMIT Attach (2) sets of Engineered Plans. * ** *PROPERTY SURVEY required for all NEW construction. ' Directions: Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement is required. (A/C upgrades over $5000) ** Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs Sewers Service Upgrades A/C Fences (Plot/Survey /Footage) Driveways -Not over Counter if on public roadways..needs ROW