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o,�-�nu-uu�u C;iry ot[ephymiils Permit Application Fax-813-780-0021 <br /> Buflding Department <br /> Date Received Phone Contact for Permittin - <br /> Owner's Name ��'/e / m�'/�/ //�{DlI�,�} Owner Phone Number $j3— �o O "DD�L� <br /> Oxvner's Address ��'�� ��2!s �2�P. ,�//eN�wti'� Owner Phone Number <br /> Fee Simple Titleholder Name � Owner Phone Number <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS .2'� � /IJE�� /E (..,RT LOT� � <br /> SUBDIVISION @Ll�D /�/f� PARCEL�D# �� al0 oZ/ � D DD�OD DoZ�p� <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED B NEW CONS7R� ADD/ALT Q SIGN Q Q DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SFR Q COMM Q 07HER <br /> TYPE OF CONSTRUCTION Q BLOCK Q FRAME � STEEL Q <br /> DESCRIPTION OF WORK �f�elL1�if3-� ��L L�f f�N c°—d Le — pZ C.�G'�-j d/(f�o� <br /> BUILDING SIZE SQ FOOTAGE C� HEIGHT <br /> OBUILDING E VALUATION OF TOTAL CONSTRUCTION <br /> QELECTRICAL � AMP SERVICE � PROGRESS ENERGY Q W.R.E.C. <br /> QPLUMBING a 3� �� <br /> OMECHANICAL $ VALUATION OF MECHANICAL INSTAILATION �� <br /> ��` 7�J' , /!� <br /> QGAS Q ROOFING Q SPECIALTY � OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES 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 CURRE� Y/N <br /> Address License# <br /> MECHANICAL - �2�,� �� COMPANY J�PS �9/IIe.°�� ��G`.TNG.1° <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address ���� /7� �°+U/CG� � /I /C`j/�S $'f� License# c����3��� <br /> OTHER COMPANY <br /> SIGNATURE REGISTEREO Y/ N FEE CURRE� Y/N <br /> Addross 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 submittai date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary FadBtles d�1 dumpster;Site Work Permit for subdivisio�s/large projects <br /> COMMERCIAL AtNach(3)complete sets of Buflding Plans plus a Llfe Safery Page;(1)set of Energy Forms.R-O-W Pertnit for new construction. <br /> Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facflities 8 1 dumpster.Site Work PeRnit for ali new proJects.Ail commercial requirements must meet compliance <br /> SIGN PERMIT Attach(2)sets of Engineered Plans. <br /> ""'PROPERTY SURVEY requlred i'or all NEW consUuctlon. <br /> Directlons: <br /> Fill out applicatfon completely. <br /> Owner&Contractor sign back of applicadon,notarized <br /> If over 52500,a Notice of Commencement fs required. (AIC upgrades 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 PERMITTING (Front of ApplicaUon Oniy) , <br /> Reroofs if shingles Sewers , Seruice Upgracles �1/C Fences(PIof/Survey/Footage) <br /> Driveways-Not over Counter if on public roadways..needs ROW <br />