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a ia-rnu-uu�u c.;ity ot�ephymills Permit Appiication Fax-813-780-0021 <br /> Building Department <br /> Date Received �/� �� 2 � �O �� <br /> L� Phona Contact for Permittin <br /> Owner's'Name , , `.t/,f G,C,•o r/ p Owner Phone Number <br /> Owner's Address � �g3 sT�fp'y Owner Phone Number � <br /> Fee Simpie Titleholder Name :` Owner Phone Number � � <br /> Fee Simpie Titleholder Addresa � <br /> JOB ADDRESS S LOT N �� <br /> SUBDIVISION PARCEL IDN <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> 1NORK PROP03ED B NEW CONSTR 8 ADD/ALT [_] SIGN Q [� DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SFR Q COMM � OTHER <br /> TYPE OF CONSTRUCTION Q BLOCK Q FRAME �� STEEL [� <br /> DESCRIPTION OF WORK �C. t� �i S �O/✓ f�x� ��• /�PS�v'�' <br /> i � G <br /> BUiLDING SIZE SQ FOOTA(3E�� HEiGHT <br /> QBUILDING a <br /> VALUATION OF TOTAL CONSTRUCTION <br /> QELECTRICAL $ AMP SERVICE 0 PROGRESS ENERGY �] W.R.E.0 <br /> QPLUMBING a <br /> � j3�� 7 <br /> ECHANICAL a� �� � VALUATION OF MECHANICAL INSTALLATION <br /> QGAS Q ROOFING Q SPECIALTY � OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO <br /> BUILDER COMPANY <br /> SIGNATURE 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 CURREP Y/N <br /> Address License# <br /> NIECHANICAL COMPANY �A C O ` <br /> 3 8 Af� ,S ,e a � <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N ,,,� � <br /> Address license# �q�0 � <br /> OTHER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# � -� <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of Buiiding Plans;(1)set of Energy Forms;R-O-W Permit for new construction, <br /> Minimum ten(10)working days aRer submfttal date. Required onsite,Construction Plans,Stortnwater Plans w/Silt Fence installed, <br /> Sanitary Fadlides 8 1 dumpster;Slte Work Permit 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 Plans,Stormwater Plans w/Silt Fence Installed, <br /> Sanitary Fadlitfes 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 requlred for all NEW conshuctlon. <br /> Directions: <br /> Fill out application completely. <br /> Owner 8 Contractor sign back of applica8on,nota�lzed <br /> If over 52500,a Notice of Commencement is required. (A!C upgrades over t7500) <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 PERMI7TING (Front of ApplicaUon Only) <br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage) <br /> Drivewaya-Not over Counter if on public roadways..needs ROW <br />