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. , 813-780-UOlU �;�ty or Gepnyrnius r�srrni�r�NNii�auv�� � ����� ,�� ���� <br /> Buiidfng Department <br /> I'Yl O N�v� <br /> Date Received J�- �(-l 2 Phone Contact for Permittln �13 Z�'�'! - � �S <br /> Owne�'s Name �� G �l o�e- S?-e.u�eNS qwner Phone Number <br /> Ownera Address � S 2-�� T Owner Phorte Number <br /> Fee 3lmple Titleholder Natne Owner Phone Number <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS �}(��.5� I�2 h sr Z��ti�Yh i 1�S ��. 3�5`�Z , � LOT# 5� <br /> SUBDIVI310N �� �O r� � PARCEL ID# O2 -Z!o'2/ 'O�SE�-D C7/�p -- OOS� <br /> (OBTAINED FROM PRpPERTY TAX NOTICE) <br /> WORK PROPOSED NEW CONSTR ADD/ALT Q SIGN [� MOVE Q DEMOLISH <br /> INSTALI B REPAIR <br /> PROPOSED USE Q SFR [� COMM Q OTHER (-- <br /> TYPE OF CONSTRUCTION � BLOCK Q FRAME Q STEEL Q OTHER <br /> DESCRIPTION OF WORK ��(�C� S;� S: ze. �L � l 2 D L � <br /> BUILDIN(3 31ZE 3Q FOOTAGE HEIGHT �� <br /> �] BUILDING $ ���� �O VALUATION OF TOTAL CONSTRUCTION �,/�Q, C5� <br /> Q ELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C, <br /> Q PLUMBINO �- 3�� v <br /> ^ � ( . <br /> [�] MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION � <br /> �] GAS Q ROOFINO � SPECIALTY Q OTHER <br /> FINISHED FLOOR ELEVATIONS � FLOOD ZONE AREA QYES QNO <br /> BUILDER ` � � d <br /> COMPANY <br /> 31GNATURE ��.� �i� � • <br /> REGISTERED N FEE CURRENT Y/N <br /> Address � � $� �9'3 I p FL 3 Z$7.8 Ucense# ��'�J�{"(� <br /> ELECTRICIAN COMPANY <br /> 81CiNA'iURE <br /> REGISTERED Y/ N FEE CURRENT Y/N <br /> Address <br /> L(cense# <br /> PLUMBER COMPANY <br /> SIGNATURE <br /> REGISTERED Y/ N FEE CURRENT Y/N <br /> Address License# � <br /> MECHANICAL COMPANY <br /> SIGNATURE <br /> REGISTERED Y/ N FEE CURRENT Y/N <br /> Address <br /> License# <br /> OTHER <br /> 81GNATURE COMPANY <br /> REGISTERED Y/ FEE CUFtR6N� Y/N <br /> Addreas � <br /> • llcense# �_u <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of�uil�ing�lans;(1)aet of Energy Forms;R-O-W Permit for new constructlon, <br /> Minimum ten(10)working days after submittal date. Required onslte,Construcdon Plans,Stormwater Plans w/Silt Fence(nstalled, <br /> San(tary Fac!Iitles 8 1 dumpster;Site Work Permlt for subdivisions/lai�.�e prolPaks <br /> GOMMEP,CIA� Attac,'�(3)s�is of Butlding Plans;(1)set of Energy Forms,R-O-W Permit`For new constructlon. <br /> Minimum ten(10)worktng days after submittal date. Requlred onsite,ConstrucUon Plans,Stormwater Plans w/Silt Fence installad, <br /> Sanitary FaGlities&1 durnpster.Site Work Permit for all new proJects.All commercial requlrements must meet compilance <br /> SIGN PERMIT Attach(2)sets ot Engineered Plans. <br /> ""PF�OPERTY SURVEY required for aH NEW constructlon. <br /> Dlrectlons; <br /> FIII out applicatlon completely. � <br /> Ovmer&Contractor slgn back of appltcadon,notarized <br /> If over s25oo,a Notice of Commencement is required. (A/C upgrades over a5000) <br /> " Agent(for the cohtractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner author(zing same <br /> OVER THE CQUNTER PERMITTING (Front of Appllcatlon Only) <br /> Reroofs � Sewers Service Upgrades q/� <br /> Fences(PIoUSurvey/Footage) <br /> Dhveways-Not over Counter If on public roadways..needs ROW <br />