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' s�s-7so-oo2o C:ity ot Gepnyrnnis rer��u� �NN���a����� <br /> Building Department <br /> Date Received �" Z S` � I Phone Contact for Permitting �� /�� —��/� <br /> Owner's Name <br /> ��� e U`�n Owner Phone Number ���� 7 `Sa`�� <br /> Owner's Address �.� �7.3� r�a- ��r� Owner Phone Number <br /> Fee 5imple Titleholder Name Owner Phone Nurriber <br /> Fee Simple Titleholder Address <br /> JOBADDRESS � � �f�a- N� • LOT# / ' � <br /> SUBDIVISION O,I�Q./1 �`�� PARCEL ID# /S '�� ����— U�s�—�c V <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED � NEW CONSTR e ADD/ALT Q SIGN � MOVE � DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE 0 SFR 0- COMM � OTHER <br /> TYPE OF CONSTRUCTION 0 BLOCK 0 FRAME � STEEL Q OTHER <br /> DESCRIPTION OF WORK /l- (�.('�n `7`� �i.Jl/��d�G� ���- �� Jl�-- <br /> BUILDING SIZE SQ FOOTAGE HEIGHT <br /> � BUILDING $ a � � a 7 `� VALUATION OF TOTAL CONSTRUCTION <br /> (� <br /> � ELECTRICAL $ A M P S E R V I C E 0 P R O G RESS ENERGY [� W.R.E.C. <br /> � PA.SCO PERMIT 3ERVICE <br /> � PLUMBING � (813) 788-5314 <br /> 0 MECHANICAL $ <br /> VALUATION OF MECHANICAL INSTALLATION �� 1 '�"� 4 " 78 9 4 <br /> GAS � ROOFING 0 � �� f� � � <br /> � SPECIALTY OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES QNO /1 <br /> BUILDER ��� ) � COMPANY �� /(�' � �� � � C • � <br /> SIGNATURE � C� i�b""`-"�r'�'�L �` REGISTERED Y/ N FEE CURRENT Y/ N <br /> Address � 7J �O�J" " � Z2 /�' � � License # <br /> ELECTRICIAN COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRENT Y/ N <br /> Address License # <br /> PLUMBER COMPANY <br /> 51GNATURE REGISTERED Y/ N FEE CURRENT Y/ N <br /> Address License # I <br /> MECHANICAL COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRENT Y/ N <br /> Address License # <br /> OTHER COMPANY <br /> SIGNATURE RHGISTERED Y/ N FEE CURRENT Y/ N <br /> Address License # � <br /> RESID�NTIAL 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 dumps#er; Site Work Permit for subdivisionsllarge projects <br /> COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms Permit for new construction. <br /> - -� - ^ - - --..._ _ r,,....,. ..,i c:i+ c.,.,,.o t.,�f�ncrl <br />