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nis-rau-uutu t;iry ot Lephymilis Permit Application Fax-813-780-0021 <br /> Building Department <br /> iJate Received g� —�Z Phone Contact for Permittin -- <br /> Owner's Name ��, `�/��--.� (C 5 Owner Phone Number �/3 `- 7C� -��� =� <br /> Owner's Addresa 3 �O-S,� �'�" � v'� Owner Phone Number �— � <br /> Fee Simple Titleholder Name Owner Phone Numbar � <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS � �U �°� S � � ,� �'� � �� �'h. ��S 3 3 S `-I-G� LOT# � <br /> SUBDIVI310N PARCEL ID# <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROP03ED e NEW CONS7R e ADD/ALT Q SIGN Q [� DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SFR Q COMM Q OTHER <br /> TYPE OF CONSTRUCTION Q BLOCK Q FRAME Q STEEL Q <br /> DE3CRIPTION OF WORK `�c_� �'��=' � � � <br /> BUILDING SIZE � SQ FOOTA(iE HEIGHT �� <br /> �BUILDING E �y�� VALUATION OF TOTAL CONSTRUCTION <br /> (.'�' <br /> QELECTRICAL a AMP SERVICE � PROGRESS ENERGY Q W.R.E.C. <br /> OPLUMBING a <br /> ��%� �(� <br /> QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION <br /> OGAS Q� ROOFING Q SPECIALTY � OTHER <br /> FINISHED FLOOR E�EVATIONS FLOOD ZONE AREA QYES NO <br /> LDER � COMP� � ��.�..�� <br /> S GNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# � <br /> ELECTRICIAN COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# �— <br /> PLUMBER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# � <br /> IMECHANICAL COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> OTHER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Addreas License# � <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Pertnit for new conshuction, <br /> Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Fadlitles d�1 dumpster;Site Work Pertnft 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 submittal date. Required onsite,Construction Pians,Stormwater Plans w!Silt Fence installed, <br /> Sanitary FaciliNes 8 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 construcdon. <br /> DirecHons: <br /> Fill out applicatlon completely. <br /> Ovmer 8 Contractor sign back of applicaHon,notarized <br /> If over 52500,a Notice of CommencemeM is required. (A!C upgrades over ST500) <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 PERMITTING (Front of Applicatlon,OMy) • <br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footagej <br /> Drivewaya-Not over Counler if on public roadways..needs ROVY. <br />