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813-780-W20 c;ity ot Lephymms rermit Hppucauon rax-a�iriov-uuc i <br /> �L f�o5�'�Ti��, ���'�'2y k;/Js wOrt�,l�' Building Department � t �- <br /> 1� c�� �'x�-�-�"„l� ��rx / 3 2`�.5�1 Z 97S <br /> Date Recei�rad <br /> '�/ Phons�ont�ct for Pe ittin . �'%3 Z.6'1 - �'{j 6 5" �►-ro.�: �f+ <br /> aaxr, - <br /> Owner's Name �1 � �a ('r'{, � �'j Owner Phone Numbsr <br /> Owners Address �d S� !'�} I �f�� Z- k%hs r'���� � Owner Phone Number � <br /> Fee 8impia Titleholder Name Ownar Phons Numbe� <br /> Fee Simple Tftleholder Address <br /> JOB AQDRES8 7� �d G��/ /� !!t� ��Z�e/�� 2liifl-S �G `� ; Se.� / LOT# � <br /> 3UBL�IaIISION �ePhR-�i(.i,�,jlS" CaJo,d'Y PARCELID# 3S'�'�-S� -�/-- C70/O - �OSOO -- ��c�c� <br /> (OBTAtNED FROM PROPERtY TIlX NOTIGE) <br /> WORIf:,PR�F�O$ED NEW CONSTI# ADD/ALT [� SIGN o o DEMOUSW <br /> INSTALL 8 REPAIR <br /> PROP�QS�fl U9E Q SFR Q COMM � OTHER <br /> TYPE OF CON8TRUCTION �] BLOCK Q FRAME � STEEL [� (�"`—""``� <br /> DESCRIPTtAN OF WORK �5t; S 7�st1 g ' 1.-�t S'T��� %�,�/L� A 1A-,ef+( - 2� (� S <br /> BUILDINQ'81ZE SQ FOOTAOE�� HEKiHT <br /> OBUILDINO � VALUATION OF TOTAL CONSTRUCTION � �l f�„�, C�d <br /> ,.�----- <br /> QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C. <br /> QPLUMBINC3 $ <br /> �� <br /> QMECHANICAL S VALUATION OF MECHANICAL INSTALLATION � -j 7 �v � � <br /> � � - <br /> QGAS � ROOFINO Q SPECIALTY � OTHER ��� ��i.Z r' <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO � <br /> � � �J '�irt''T� <br /> BUILDER �-�'�/') \ COMPANY S i 1''1 I2'�G/t j I��1g �.f <br /> SIGNATURE �� 1 / � ' "�-�-' REGISTERED Y/ I� h'Ee CuR�� Y/N <br /> Address E� � r �n PA F 33��' License# � ��pp 12 ( ( , <br /> LLECTRICWV COMPANY <br /> s�Q�T�� RECaISTERED Y/ N FEE CURRE� Y/N <br /> Address Licer�se# � <br /> PLUMBER° COMPANY <br /> SIONA?URE REGISTERED Y/ N FEE CURRE� Y/N <br /> Addroas ucense# � <br /> MECHANICAL. COMPANY <br /> $���N� REGI3TERED Y/ N FEE CUFtf4E� Y/N <br /> Address Ucense# t <br /> OTHER COMPANY <br /> s�0�Y�1� REQISTERED Y/ N FEe curtr�n Y./N <br /> Address Ucense# t <br /> RE81D'�NTIAL Atlac;h(2)Plot Plans;(2)sets of Bulkfing Plans;(1)set of Ener9Y Forms;R-O-W Pannit for new constructlon, <br /> Minimum ten(10�working days after submittal date. RequiFed onalte,ConstrucUon Plans,StoRnwater Pians w/Silt Fence Inatalled, <br /> Sanit�ry-F�dlides 81 dumpster;Site Work Permit br subdivislonsllarge proJects <br /> CONiMERCWL Att�ach(3)�mpie:e sets of Building Plans plus a Life Safsty Pa�e;(1)set of Energy FoRns.R-O-W Pesmit br new construcUtln. <br /> Minimum ten(10)wo►icing days after submittal date. Required onsite,Constructlon Plans,Stormwater Plans w/Silt Ferl�e'instaUed, <br /> Sanitary Fadlides 81 dumpster.Sfte Work Permit for all new projects.Ali commerctal requtrements must meet compllance <br /> SI(iN PERMIT Attach(2)sets:of E�gineered Plane. <br /> '"•'PROPERTY SURVEY requlred for all NEW constructlon. <br /> Diroctions: <br /> Fill out appiicaUon completely. <br /> Owner 8 Contractor sign back of appltcaHon,notarized <br /> If over.=2S00,a Notice of Commencement is requlred. (A/C upgrades ovar i7s00) <br /> *• Agerrt(for the contractor)or Power of Attomey(for the owner)would be someone with nota�ized letter from owner author(zing same <br /> OVER THE COUNTER PERMIiTING (Front of Appllcatlon Only) <br /> Reroofs if ahingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage) <br /> D�Ivevrays-Not over Counter if on publia roadways..needs ROW <br />