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ais-inu-wzu C;iry ot Lephymiils Permit Application Fax-813-780-0021 <br /> Building Department <br /> Date Received � � � Q � Phone Contact for Permittin �J��L � - (/ <br /> " �. <br /> Owner's Name �G � Owner Phone Number • l - �6 <br /> Owner's Address Owner Phone Number <br /> Fee Simpie Titleholder Name Owner Phone Number <br /> Fee Simple Titleholder Addresa <br /> JOB ADDRESS r� ��� �Z � � r / LOT* � <br /> SUBDMSION PARCEL IDN <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> 1NORK PROPOSED NEw CONSTR ADD/ALT Q SIGN Q Q DEMOLISH <br /> B INSTALL 8 REPAIR <br /> PROPOSED USE Q SFR Q COMM Q OTHER <br /> TYPE OF CONSTRUCTION Q BLOCK Q FRAME Q STEEL Q <br /> DESCRIPTION OF WORK IV� <br /> BUILDING SIZE � � S SQ FOOTAGE O���� HEIGHT O�l�- S�"^ <br /> OBUILDING 3 ' 6 � U� VALUATION OF TOTAL CONSTRUCTION <br /> J <br /> �ELECTRICAL a AMP SERVICE Q PROGRESS ENERGY �W.R.E.C. <br /> QPLUMBING a �Nt <br /> �1/l� <br /> f <br /> OMECHANICAL S VALUATION OF MECHANICAL INSTALLATION <br /> � `'� ��`� ! - f <br /> QGAS Q ROOFING Q SPECIALTY Q OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO <br /> /f � <br /> BUtLDER /,// � � - � �t COMPANY <br /> SIGNATURE l� REGISTERED Y/ N FEE CURRE� Y/N <br /> Addreas ' 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 /> Addreas License# � <br /> AIIECHANICAL COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> OTHER COMPANY <br /> SIGMATURE REGISTERED Y J 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 Permit for new construction, <br /> Minimum ten(10)working days aRer submittal date. Required onsite,Construction Plans,Stormwater Plans wl Silt Fence installed, <br /> Sanitary FadllUes 8 1 dumpster;Site Wor1c Permit for subdivisionsllarge projects <br /> COMMERCIAI Attach(3)compiete sets of Bullding 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,Constructfon Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary FaciNties 8 1 dumpster.Site Work Pennit for all new projects.All commercial requirements must meet compliance <br /> SIGN PERMIT Attach(2)sets of Engineered Plans. <br /> "•'PROPERTY SURVEY requfred for all NEW constructlon. <br /> DirecHons: <br /> FlII out application completely. <br /> Owner 8 Contractor sign back of applicatlon,notarized <br /> If over i2500,a NoNce of Commencement is required. (AIC upgrades over 57500) <br /> '• Agent(for the contractor)or Power of Attomey(for the owner)would be someone wfth notarized letter from owner authorizing same <br /> OVER THE COUNTER PERMITTING (Front of AppNcaUon a�ly) ' � •����� ' <br /> Reroofs if shingles Sewers Service Upgrades A/C l�ences(Plot/Survey/Footage) '. <br /> a <br /> Driveways-Not over Counter if on public roadways..needs ROW <br />