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o i�-iau-vu�u city ot �epnyrnu�s Nermit App��cation Fax-813-780-0021 <br /> Building Department <br /> Date Received -����� r Phone Contact for Permitting /� `,� __ a ,2`�'� ' <br /> Owner's Name ' `� �* V� /�,q w Owner Phone Number <br /> Owner's Address �� �l � U j��p �c� H dl. Owner Phone Number <br /> Fee Simple Titleholder Name Owner Phone Number <br /> Fee Simple Titleholder Address <br /> JOB AD�RESS I `D) f �U f'�1 J f' LOT # �� <br /> SUBDIVISION [ T /�I PARCEL ID# D • a -oZ - QO O U/00 ' 0,�00 <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED e NEW CONSTR 8 ADD/ALT � SIGN Q 0 DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE � SFR � COMM �� OTHER <br /> TYPE OF CONSTRUCTION � BLOCK � FRAME � STEEL � <br /> DESCRIPTION OF WORK ;yt.�oy / r �}�..►.,, r; �� j��r JI t <br /> BUILDING SIZE C SQ FOOTAGE� HEIGHT <br /> � rrrrr r <br /> OBUILDING $ �� VALUATION OF TOTAL CONSTRUCTION <br /> DELECTRICAL $ AMP SERVICE � PROGRESS ENERGY � W.R.E.0 <br /> �PWMBING �� �� <br /> OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION �� <br /> OGAS � ROOFING � SPECIALTY � OTHER <br /> FINISHED FLOOR ELEb'ATIONS FLOOD ZONE AREA �YES NO <br /> — � <br /> S GNATURE iG" `1 � i � COMPANY ' �c�dW d✓c� � u � /��a /J � <br /> REGISTERED Y l N FEE CURRE� / N <br /> Address �j ci i` - r'r/ , (r;,y - i,/ � - License# S�G l���SQ 9}� � � <br /> ELECTRICIAN � COMPANY <br /> SIGNATURE REGISTERED Y! N FEE CURRE� Y/ N <br /> Address C License # <br /> PLUMBER � COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address C License # �- � <br /> MECHANICAL � COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address C License # <br /> OTHER � COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address C 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 /> Minim�.�m ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, <br /> Sanitary Facilities & 1 dumoster• Si1P Wr,rk PP�..,�r E„� ���h,��„���,,.,�n ....... .....:....... <br />