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s�s-7so-oozo City or�epnyrnnis r�rl�n�HNN���a����� � <br /> . Building DepartmenY <br /> Date Received �2?� v Phone Contact for Permitting ��� 7�� `���� <br /> -r1- <br /> ytm . <br /> Owner's Name �a-/��I�.� /�Q� • Owner Phone Number <br /> Owner's Address 'y�t /�� � "���e Owner Phone Number[ <br /> Fee 5imple Titleholder Name Qwner Phone Nurriber[ <br /> . • . .� <br /> Fee Simple Titleholder Address = <br /> JOB ADDRESS ��t/ V��Y�w�v' '�/�f� , � � LOT� � <br /> SUBDIVISION • U r��"� PARCEL ID# �y��- ��d'� �� � a�` <br /> , (OBTAINED FROM PROPERTYTAX NOTICE) <br /> WORK PROPOSEO ' NEW CONSTR e ADDlALT �] SIGN � MOVE [� DEMOLISH <br /> � INSTALL RCPAIR <br /> PROPOSED USE' 0 SFR [� • COMM 0 OTHER � <br /> TYPE OF CONSTRUCTION 0 BLOCK L� FRAME ' .0 STEEL 0 OTHER <br /> DCSCRIPTION OF WORK S�Q� �G� � J��'�"�'� '����UI� ' <br /> X eL7 HBIGHT 9 , � <br /> BUILDING SIZE SQ 1=00TAGE <br /> ' � BUILDING $ /�/ �� 6� VALUATIONOFTOTALCONSTRUCTION <br /> 7 <br /> � ELECTRICAL $ AMP SERVICE � PROGRESS ENERGY [� W.R.E.C. <br /> � ��P�RP�ABi°���t/!�� <br /> 0 PLUMBING � (813)78�-53�� <br /> FA�C 1-�-�24%�4�� <br /> 0 MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION . 23 <br /> OTHER �� �2 <br /> � GAS � ROOFING � SPECIALTY 0 . <br /> FINISHED FLOOR ELEVATIONS 1=LOOD ZONE AREA DYES [�NO <br /> ���_ _� ' I �Sti COMPANY ���f �^ • �� • <br /> S G'NATURE �r��� ������ � REGISTERED Y! N FEH CURRENT Y/N <br /> Address �� ��r�� �' , License# <br /> ELECTRICIAN • COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRENT Y/N <br /> � License# <br /> Address. <br /> PLUMBER COMpANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRENT Y/N <br /> Address License# I <br /> MECHANICAL COMPANY . <br /> SIGNATURE • REGISTERED Y/ N �FEE CIJRRENT Y/N <br /> License# <br /> Address <br /> OTHEF2 � COMPANY ' <br /> SIGNATURG RHGISTERED Y/ N FEE CURRENT Y/N <br /> Address License# � <br /> RESID�NTIAL Attach(2)Plof Plans;(2)sets of Building Plans;(1)seY of Energy Forms;R-O-W Permit for new construction, <br /> Minimum ten(10)worl<ing days after submittal date. Required onsite,Constructlon Plans;Stormwater Plans w/Silt Fence instalied, <br /> Sanitary Facilities&1 dumps�er;Site Worlc Permit for subdivisions/large projects <br /> COMMERCIAL Attacli(3)complete sets of Building Plans plys a Life Safety f'age;(1)set of Energy Forms.R-O-VV 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 I=acilities&1 dumpster.Site 11Vor1<Permit for all new projects.Ail commercial requiremenis must meet compliance <br /> SIGN PERMIT Attach(2)sets of Engineered Plans. <br /> '***PF20PERTY SURVEY roquired for all NEW construction. • <br /> -'-'-I-H-I-I-1-f-t-1-hH-l-I-Ff-I+f+H-1-H-I-1-1-1+1-N-1-H-I-1-1-I-1-1-1-1-H-I-H-1-I-l+H-l-H-I-1-H-1-H-H-H-1-1-FI-FH-hH+hFhHa-(-l-I-N+1-hf-H-I'H'hM-f-1-1-I-rri-rrri-rrri-n'ri-i-i-r�i°�`�� <br /> -rr-i-,-R;°h H°r1��� <br /> Direcfians: , . <br /> Fill out application completely. . <br /> Owner&Contractor sign back of application,notarized <br /> If over$2500,a NoEice of Commencement is required. (A!C upgrades over$5000) <br /> ** Agent(for the contractor)or Power of Attorney(for the owner)would be someone wiEh notarized letter from owner authorizing same <br /> OVER THE COUNTER PERMITTING (Front of Application Only) � <br /> Reroofs Sewers Service.Upgrades A/C f-ences(PlotlSurvey/Footage) <br /> Driveways-Not over Counter if on public roadways.:needs ROW <br />