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°7-'tlU""""' Lity ot�ephymills Permit Application Fax-813-780-0021 <br /> Bufiding Department <br /> Date Recefved <br /> Phone Contact for Permittin __ <br /> Owner's Name d - � _ Owner Phone Number <br /> Owner's Address � Cj.� 5 ° <br /> - �--���-�- Owner Phone Number <br /> Fee Simple Titleholder Name Owner Phone Number � � <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS �� 1 � ��-� �' �� LOT# � <br /> SUBDNISION G � • PARCEL iD�l! ��. Z Cd Z l C�2. 3O Q�5�0 DO`T� <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED B NEW CONSTR 8 ADD/ALT �] SIGN [� [� DEMOIISH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SFR Q COMM � OTHER <br /> TYPE OF CONSTRUCTION Q BLOCK Q FRAME U STEEL Q <br /> DESCRIPTION OF WORK � P C�O C3—C J1(1 1 �C1 G l_ � <br /> BUILDING SIZE SQ FOOTAGE \3�� HEIGHT � <br /> QBUILDING S �����- VALUATION OF TOTAL CONSTRUCTION <br /> QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY <br /> [� W.R.E.0 <br /> OPLUMBING s <br /> ��3��� <br /> OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION <br /> OGAS � ROOFING Q SPECIALTY �� OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO <br /> BUILD r----- COMPANY C�I �_� �� _� ` p �r1 <br /> SIGNATURE � REGISTERED Y/ N FEE CUR E� Y/N <br /> Address �i�-1 ci J t � Y� '� .1 ��l� � lS J 3��-t I License# C GG U�� 1 �-�� <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 COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# —� <br /> OTHER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURREP Y/N <br /> Addreas License# � <br /> RESIDENTIAL Attach(2)Piot Plans;(2)sets of Building Plans;(1)set of Energy Fortns;R-O-W Permit for new construction, <br /> Minimum ten(10)working days aRer submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facifltles 8 1 dumpster;Site Work Permit for subdivisions/large proJects <br /> COMMERCIAL Attach(3)complete sets of 8uilding Plans plus a Life Safey Page;(1)set of Energy Forms.R-O-W Permit for new constructfon. <br /> Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities 8 1 dumpster.Site Work Permit for ail new proJects.All commerc(al requirements must meet compliance <br /> SIGN PERMIT Attach(2)sets of Engineered Pians. <br /> ""PROPERTY SURVEY required for all NEW constructlon. <br /> Directions: <br /> Fili out application completely. <br /> Owner&Contractor sign back of appBcatlon,notarized <br /> If over i2500,a Notice of Commencement ia requi►ed. (A/C upgrades over 5750�}►+��,�.F6�.. .; „,�,., w,�� � �Y � <br /> .. aa.,.,a�w,, �. <br /> Agent(for the contractor)or eone witf��notarized letter from owner authorizing sam�, <br /> OVER THE COUNTER PERMI G (Front of AppflcaUon Only) � , <br /> Reroofs if shingles Sewers Service Upgrades A/E � Fenoes(Plo�'Survey/F�tage) <br /> .,'.,, , 'r <br /> Driveways-Not over Counter on public roadways..needs ROW ' ' <br /> , ,,,.,�-, <br />