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���-�au-vu�u (;fty ot Lephyrhilis Permit Application Fax-813-780-0021 <br /> Building Department <br /> Date Received Phona Contact for Permittin �l J ��� -- J`�o��oZ <br /> Owner's Name �N��A D �'� Owner Phone Number <br /> Owner's Addresa �O lPs /o'�T��l�� Owner Phone Number � <br /> Fee Simple Titlehoide�Name Owner Phone Number �- <br /> Fee Simple Tftleholder Address <br /> JOB ADDRESS LOT� C� <br /> SUBDIVISION PARCEL ID!! /l�a�� �I"L ��/D"C- ��'L%U 'QL��`�3 <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> NUORK PROPOSED � NSTALLSTR 8 REPAIR � SIGN Q Q DEMOLISH <br /> IPROPOSED USE Q SFR Q COMM Q OTHER �- <br /> TYPE OF CONSTRUCTION Q BLOCK Q FRAME Q STEEL Q <br /> DESCRIPTION OF WORK � ,C�A/N �iN� GG NG'�� -� <br /> BUILDING SIZE � SQ FOOTAGE �/a r HEIGHT �rS / � <br /> �BUILDING S� � v p VALUATION OF TOTAL CONSTRUCTION <br /> O� <br /> QELECTRICAL a AMP SERVICE Q PROGRESS ENERGY,,�--�� W.R.E.0 <br /> � �f: <br /> QPLUMBING a f ' �� <br /> QMECHANICAL $ VALUATI�N OF MECHANICAL INSTALLATION � ,✓� '' <br /> � <br /> QGAS Q ROOFING Q SPECIALTY 0 OTHER �. _ <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO <br /> BUILDER /_ , COMPANY P��C d ��'N�� !; U <br /> SIGNATURE v" + REGISTERED N FEE CURREI+ /N <br /> Address License# � � <br /> ELECTRICIAN COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURREP Y/N <br /> Address License# � <br /> PLUMBER � COMPANY <br /> SIGNATURE REGISTERED Y J N FEE CURRER Y/N <br /> Address License# � <br /> MECHANICAL � COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURREI+ Y/N <br /> Address License# � <br /> OTHER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y!N <br /> Addresa License# � <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set oi Energy Forms;R-O-W Permit for new construction, <br /> Minimum ten(10)working days after submfttal date. Required onsite,Construction Plans,Stormwater Plans w!Silt Fence installed, <br /> Sanitary Fadlides�1 dumpster;Site Work Permit for subdivisfonsliarge projects <br /> COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(1)set oi Energy Forms.R-O-W Permit for new construction. <br /> Minimum ten(10)working days aiter submittal date. Required onsfte,Constructfon Plans,StoRnwater Plans w/Silt Fence instailed, <br /> Sanitary Fadfldes 6 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 consVuction. <br /> DlrecNons: <br /> Fill out application completery. <br /> Owner&Contractor sign back of application,notarized <br /> If over t2500,a Notice of Commencemant is required. (AIC upgredas over 57500) <br /> `• Agent(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same <br /> OVER THE COUNTER PERMI'TTING (Front of AppflcaUon Only) <br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoVSurvey/Footage) <br /> Drivewaya-Not over Counter if on public roadways..needs ROW <br />