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813-780-0020 City or Lepnymiiis rer�►u� HNN���a����� �/��� <br /> Building Department <br /> Date Received '( � Phone Contact for Permitting o�� � "��/+ <br /> Owner's Name .i`T ` /G� Owner Phone Number <br /> Owner's Address d 4 9d3 L d ib�-+�J �-�/v Owner Phone Number <br /> Fee Simple Titleholder Name Owner Phone Nurriber <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS s��- � ���' L07 # �I <br /> SUBDIVISION • � � ��°�" PARCEL ID# ° —� ��� �d'�� J L�C.b — � 7S� <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED � NSTALONSTR e REPAIR � SIGN 0 MOVE [� DEMOLISH <br /> �� COMM 0 OTHER <br /> PROPOSED USE Q SFR �• <br /> TYPE OF CONSTRUCTION 0 BLOCK � FRAME 0 STEEL 0 OTHER <br /> ' �C a�.� �r �vu��l �/� <br /> DESCRIPTION OF WORK O Q '� ��� <br /> BUILDING SIZE �y �`s a' SQ FOOTAGE �� HEIGHT <br /> � BUILDING $ i� 5 :�� � VALUATION OF TOTAL CONSTRUCTION <br /> � ELECTRICAL $ ' (� AMP SERVICE � PROGRESS ENERGY C] W.R.E.C. <br /> �oo• �T� <br /> , PAS(� PERMIT SERVICE <br /> 0 PLUMBING � ($13) 788-5314 <br /> � FAX 1-$66-82eE-7�4 �,, <br /> MECHANICAL $ 5 ..��� � VALUATION OF MECHANICAL INSTALLATION ,�� <br /> �� r✓y }� <br /> 0 GAS 0 ROOFING � SPECIALTY 0 OTHER (") '` ��� <br /> � <br /> FINISHED FLOOR ELEVATIONS � FLOOD ZONE AREA �YES �NO <br /> BUILDER � ` ��Q, ,�„� �(' ��(}� <br /> COMPANY V �f¢'�'K ` � � <br /> SIGNATURE ^"`�'w REGISTERED Y/ N FEH CURRENT Y/ N <br /> Address � � l� �" /�L lf�( .� ' License # <br /> ELECTRICIAN � � ' �� COMAANY /'!(I� �1��- <br /> SIGNATURE C\ ��� ' _ � ���"' - " - `J � REGISTERED Y / N FEE CURRENT Y / N <br /> Address � • � � �C7d ,� `.rc3 7 i' � � License # <br /> PLUMBER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRENT Y/ N <br /> Add�ess License # I <br /> MECHANICAL � � R � COMPANY �° f ��� a�- �""" �� <br /> SIGNATURE ��� //�� REGISTERED Y/ N FEE CURRENT Y/ N <br /> Address /c-� � ' License # <br /> OTHER COMPANY ' <br /> SIGNATURE REGISTERED 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) wori<ing 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 construc8on. <br /> Minimum ten (10) worlcing days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, <br /> Sanitary Facilities & 1 dumpster. Site Wori< Permit for all new projects. All commercial requirements must meet compi(ance <br /> SIGN PERMIT Attach (2) sets of Engineered Plans. <br /> ****Pf20PER7Y SURVEY required for ail 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 P;ttorney (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 />