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813-780 -0020 City of Lepnyrnnls relm!' tAppn auvi1 .. i 1 / rq <br /> /10 x Building Department I l <br /> Date Received l V �l U Phone Contact for Permitting dX. !G __ 5 3u1 <br /> L /� - <br /> Owner's Name /�-�/ Ie - /�-1 aJE / '/ / - -- Owner Phone Number S. 7V —FM 3.0 <br /> Owner's Address 3 pS� - CAlt-r/df� Owner Phone Number <br /> Fee Simple Titleholder Name Owner Phone Number <br /> Fee Simple Titleholder Address '/ <br /> JOB ADDRESS a 9Sav / ./'t( / Gut LOT # aJY <br /> SUBDIVISION /n€`/r)4C leaf PARCEL ID# Dif ' -/ ockV — ad/do - Qd 9a <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED iti NEW CONSTR ADD /ALT I I SIGN I 1 MOVE I I DEMOLISH <br /> INSTALL REPAIR , <br /> PROPOSED USE I 1 SFR I I - COMM I t\ I OTHER I6t � lt./LL/j(/ At I <br /> TYPE OF CONSTRUCTION I I BLOCK I I FRAME I 1 I STEEL I 1 OTHER I I <br /> DESCRIPTION OF WORK �- -d "4T ,'- <br /> BUILDING SIZE 43 X 36 SQ FOOTAGE 'i-J '6 HEIGHT <br /> V BUILDING J <br /> $ , // O dd 64 VALUATION OF TOTAL CONSTRUCTION <br /> It ELECTRICAL $ ?do.. �" OQ AMP SERVICE (�`- � PROGRESS ENERGY I ( W.R.E.C. <br /> I I PLUMBING $ _. <br /> MECHANICAL $ 50 00 VALUATION OF MECHANICAL INSTALLATION <br /> I I GAS I I ROOFING 1 I SPECIALTY I I OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA I IYES I 1NO <br /> BUILDER // (-- OMPANY 1 .-r401 �K ..Zt <br /> SIGNATURE ...e. Atieli aJ f J <br /> t-" ! REGISTERED I Y/ N I FEE CURRENT I Y/ N <br /> Address (. /S`S/ re/ 7 le-10 404104 N. License # <br /> ELECTRICIAN 144_4)1 gr/ / COMPANY /''0, 7�0 . etGQ'-azrec <br /> SIGNATURE <br /> J b! REGISTERED I Y/ N I FEE CURRENT I Y/ N <br /> Address P' 0 • #60x. X5J7 2 4/�hi F( <br /> / <br /> tt// License # <br /> PLUMBER I COMPANY <br /> SIGNATURE I REGISTERED I Y/ N I FEE CURRENT Y/ N <br /> Address I I <br /> I License # T <br /> MECHANICAL — &4 4 /� tn I / i COMPANY �� 2k //0/210 Ar 14 /1/e SIGNATURE i'-1�w <br /> �� REGISTERED I Y/ N FEE CURRENT I Y/ N I <br /> Address I * VW ./4 , I 4/4tia IC/, I License # <br /> OTHER I <br /> I COMPANY <br /> SIGNATURE REGISTERED Y / N FE E CURRENT <br /> I ..1 I Y / N I <br /> Address I License # <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 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 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 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 /> Directions: <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized <br /> If over $2500, a Notice of Commencement is required. (A /C upgrades over $5000) <br /> '* Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same <br /> OVER THE COUNTER PERMITTING (Front of Application Only) <br /> Reroofs Sewers Service Upgrades A/C Fences (Plot/Survey /Footage) <br /> Driveways -Not over Counter if on public roadways..needs ROW <br />