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813-780-0020 City ot �epnyrnnis rerr���� H�N���a���� � � <br /> . Building Department <br /> Date Received r Phone Contact for Permitting 3 7� .— `rd ` Y <br /> Owner's Name �"Q-U� a f" `�-� ����K+4'°` Owner Phone Number �� � f.3 � � <br /> Owner's Address � 7 �� /����� �^�/ Owner Phone Num�er <br /> Fee Simple Titleholder Name Owner Phone Nurriber <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS <7 7 �31 ' �` l ��� � �/ , LOT #� �'� � <br /> SUBDIVISION • �/ �I" (/ !� /` � ' PARCEL ID# �3 ��`-r0 " — Q��� ���� � <br /> . (OBTAINED FROM PROPERTYTAX NOTICE) <br /> WORK PROPOSED NEW CONSTR ADD/ALT 0 SIGN � MOVE �] DEMOLISH <br /> � INSTALL e REPAIR <br /> PROPOSED USE Q <br /> SFR 0• COMM � OTHER <br /> TYPE OF CONSTRUCTION 0 BLOCK � FRAME �. � STEEL 0 OTHER <br /> DESCRIPTION OF WORK ' ��� ���� �� v <br /> BUILDING SIZE �� x'�7 SQ FOOTAGE °'�� HEIGHT <br /> � BUILDING $ ��d� B�' VALUATION OF TOTAL CONSTRUCTION <br /> 0 ELECTRICAL $ AMP SERVICE 0 / PROGRESS ENERGY Q W.R.E.C. <br /> PLUMBING � � � ��� �'� �E�MIT ���?���L� <br /> � (S13) 788-53� � <br /> � , �FAX 1 �56-8247�9 <br /> MECHANICAL � VALUATION OF MECHANICAL INSTALLATION �� �� `� <br /> 1/ <br /> 0 <br /> GAS 0 ROOFING 0 SPECIALTY [� OTHER ��r�� , <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES Q A' � n '�1��� <br /> . � !� , <br /> BUILDER � Q � �,/�� �, �� COMPANY �Q-f U�' <br /> SIGNATURE i�� `"' ""l � REGISTERED Y/ N FEE CURREN7 Y/ N <br /> Address y dd3� /�' �Q/�- �/r • Z ' License # <br /> ELECTRICIAN • COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRENT Y/ N <br /> Address � License # <br /> PLUMBER COIVIPANY <br /> SIGNATURE ftEGISTERE� 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 Pians; (2) sets of Building Plans; (1 } set of Energy Forms; R-O-W Permit for new construction, <br /> Minimum ten (10) worl<ing days after submittal date. Required on$ite, Construction Pians, Stormwater Plans w/ Silt Fence instalied, <br /> Sanitary Facilities & 1 dumps�er, Site Woric 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 Permlt for new construction. <br /> Minimum ten (10) worl<ing days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, <br /> Sanitary Facilities & 1 dumpster. Site 1Nor1< Permit for all new projects. All commercial requirements must meet compliance <br /> SIGN PERMIT Attach (2) sets of Engineered Plans. <br /> ****PROPERTY SURVEY requfred for all NEW construction. � <br /> .�.._ ��: .+. .� <br /> ���' <br /> Directions: <br /> Fill out application completely. ' <br /> Owner & Contractor sign back of application, notarized ' <br /> If over $2500, a Nofice of Commencement is required. (AfC 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 (PIoUSurvey/Footage) <br /> Driveways-Not over Counter if on public roadways.:needs ROW <br />