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813-780-0020 City ot Lepnyrhllls Nermit Application rax-u,s-�au-uuz, <br /> Building Department <br /> Date Receiv�cl � <br /> � Phone Contact for Permitttn _ <br /> �"' Owner's NamE� * Owner Phone Number -� Q <br /> � Owner's Address ' Owner Phone Number � <br /> Fee Simple Titleholder Name Owner Phone Number <br /> Fee Simple Titleholder Address <br /> '' JOB ADDRESS LOT # � <br /> SUBDIVISION - PARCEL I�# <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED NEW CONSTR ADD/ALT [� SIGN [� [� DEMOLISH <br /> e INSTAIL � REPAIR <br /> PROPOSED USE � SFR Q COMM �� OTHER <br /> TYPE OF CONSTRUCTION Q BLOCK Q FRAME � STEEL Q - -1 <br /> � DESCRIPTION OF WORK <br /> BUILDING SIZE SQ FOOTAGE � HEIGHT <br /> QBUILDING $ —' <br /> VALUATION OF TOTAL CONSTRUCTION <br /> � �ELECTRICAL $ AMP SERVICE <br /> �j a� 6� 0 PROGRESS ENERGY Q W.R.E.C. <br /> QPLUMBING $ <br /> QMECHANICAL �$ VALUATION OF MECHANICAL INSTALLATION <br /> L <br /> QGAS Q ROOFING Q SPECIALTY <br /> C� OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO <br /> BUILDER <br /> SIGNATURE COMPANY <br /> REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address � <br /> License # <br /> (-ELECTRICIAN /,� �?7 <br /> SIGNATURE �(,(/ COMPANY ( <br /> REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address License # � <br /> PLUMBER <br /> SIGNATURE COMPANY <br /> REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address Ucense # �— <br /> MECHANICAL COMPANY <br /> SIGNATURE <br /> REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address License # �— <br /> OTHER <br /> SIGNATURE COMPANY <br /> REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address � <br /> License # <br /> RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permit for new constructlon, <br /> Minimum ten (10) working days after submlttal date. Required onsite, Constructlon Plans, Stormwater Plans w/ Sitt Fence installed, <br /> Sanitary Facilities 8 1 dumpster; Site Wor1c Permit for subdivisions/large projects <br /> COMMERCIAL Af�ch (31 rmm�lo►e �e�� ,.s o..����__ ... _ <br />