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"„' ""-"""' �ity ot�epnyrn�ns Permit Application Fax-813-780-0021 <br /> Building Department <br /> Date Received _� , � <br /> Phone Contact for Permitting �� `� __ ��� <br /> Owner's Name �NG � f L[L v�. Owner Phone Number <br /> Owner's Address 3 5 y L�� � N„r}.���,� Owner Phone Number [ <br /> Fee 5imple Titleholder Name Owner Phone Number [ <br /> Fee Simple Titleholder Address � <br /> JOB ADDRESS �7 y�� u �f� j o H,�} ] LOT# �� <br /> SUBDIVISION PARCELID# o�y-�Il, -,?�•- DDOO 'OU�QU "ODr'JD � <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED NEW CONSTR ADD/ALT �� SIGN Q � DEMOLISH <br /> INSTALL 8 REPAIR <br /> PROPOSED USE SFR � COMM �� OTHER � <br /> TYPE OF CONSTRUCTION BLOCK � FRAME C� STEEL � �--� <br /> DESCRIPTION OF WORK ��,n pl�V t���j����� f f��� ��, J12t / <br /> BUILDING SIZE SQ FOOTAGE� HEIGHT �� <br /> �BUILDING $ <br /> J VALUATION OF TOTAL CONSTRUCTION <br /> �ELECTRICAL $ � AMP SERVICE � PROGRESS ENERGY <br /> � W.R.E.C. <br /> �PLUMBING $ <br /> � Z,���G <br /> OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION <br /> OGAS � ROOFING Q SPECIALTY � OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES NO <br /> BUILDER � COMPANY U�'+q/o� h/Gr J p� T A � <br /> SIGNATURE � � REGISTERE� Y N FEE CURRE� /rJ <br /> Address 0 li��l�;,i�;/ �� - License# C�G �,�Q 9 <br /> ELECTRICIAN COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# C � -� <br /> PLUMBER COMPANY � <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# C -� <br /> MECHANICAL COMPANY _� <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# C <br /> OTHER COMPANY <br /> SIGNATURE REGISTERED Y! N FEE CURRE� Y/N <br /> Address License# C � <br /> RESIDENTIAL 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 8�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 construction. <br /> Minimum ten(10)working days after submlttal date. Required onsite,Construction Plans,Stormwater Plans w/Silk Fe�ce installed, <br /> Sanitary Facilities& 1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance <br /> SIGN PERMIT Attach(2)sets of Engineered Plans. <br /> '""PROPERTY SURVEY required for all NEW construcUon. <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$7500) <br /> " Agent(fo�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 if shingles Sewers Service Upgrades A/C Fences(PIoVSurvey/Footage) <br /> Driveways-Not over Counter if on pub�ic roadways..needs ROW <br />