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813-780-002D Gi��y o1��epnyrnn�s ►��rt�u�r�NN����«��� • <br /> . • . Building DepartmenE <br /> � , . . �'/3 ld� . - S�3// . . <br /> DateReceived 2.� �9—� � nhonoConfiaciforPermitting ��'__ _____ _ _ <br /> -rrrrrrr►-�-rrrrrr - / - -�-rn-�-rH - rrt- _ _ <br /> Owner's Name /� (�- ��-'n-" S ��J� �i � Owner Phone Number d�����y`7�� <br /> Owner's Address .3• �7 a� ���d��/�� �""' Owner Phone NumUer[ <br /> Pee 5imple Titloholder Name • Owner Phone NurriUer[ <br /> Fee Simple Titleholder A�Idress ' � �� <br /> JOB ADDRESS <br /> 3d ?d/ �Gc>��� ��'�� ' LOT�� � <br /> '/ OeL -ezG dot.`U-0�-00�6d <br /> SUI3pIV1SI0N ' • � �/"0�% ���� PARCCI..ID# °� <br /> • ' E J ' (ODTAINED FROM PROPERTY TAX NOTICG) <br /> WORK PROPOSCD ' NGW CONSTR � ADD/AI.T [� SIGN 0 NIOVE [� DGMOLISFI <br /> � INSTALL . I�EPAIR <br /> Sr� ' �• COMM � OTI-IER � <br /> PROP05ED USE' • C� STCCL 0 OTMER <br /> TYPC O�CONSTRUCTION � l3LOCK � FRAME � .0 <br /> DCSCRIPTION OF WORK ' s , <br /> BUILDING SIZG �� X l� SQ("OOTAGC ��OZ 7 I-iE(G(-IT �� <br /> � [3UILDING � 3 �yQQ VALUATION Of-TOTAL CONSTRUCTION , <br /> �] ELE.CTRICAL ;� . AMf'SLRVICC 0 PROGRG�3S GNCRGY [� W���•C• <br /> . . PAS(�O PERMIT SERVICE <br /> �[� I'LUMBING a� IF�13�4-i� - . <br /> 0 MCCI-IANICAL $ VALUATION OF MECI-IANICAL INSTALLATION . ' �� 3� <br /> � R001=1NG � SPECIALTY � OTHCR , � <br /> � GAS [�] <br /> �INISI-IED FLOOR CLEVATIONS �I 1=LOOD ZONE AREA [�YGS [�NO <br /> � <br /> COMPANY v�� �`r � ` "�C � <br /> I3UILDCR ' ��! �� + RCGIST[RED Y/ N fEE CURRCNT Y!N ' <br /> SIGNATURC <br /> Acldrass �G y � �4� � � � • �r�°L . License� <br /> GLGCTRICIAN • COMPANY <br /> SIGNATURC REGISTGRGD Y I N FGE C'URRCNT Y/N <br /> , • License# <br /> Addres� <br /> PLUMBER . � COfUI�'ANY <br /> 51GNATURE RCGISTERED Y/ N FGG CURRENT Y/N <br /> License# <br /> Add�oss <br /> MECI-IANICAL ' ' COMPANY • <br /> 51GNATURE • REGISTERED Y/ N hCE CURRHNT Y(N � <br /> License# <br /> Address � ' • , <br /> OTHCR • � COMPANY � <br /> SIGNA'1'URC RCGISTERED Y/ N �G8 CURRENT Y!N <br /> � ' License# � <br /> Address ' <br /> RCSID�NTIAL Attach(2)I'lof Plans;(2)sets oi Building Plans;(1)seC of Gnergy Forms; <br /> R-O-W Permlt for new c;onstrucEion, <br /> Mlnimum ten(10)worlcing days after submiltal date. Required onsite,Cops[ruction Plans;Stormwater I'lans w/Silt Fence fnstalled, <br /> Sanitary 1=acillties&1 dumps#er,Site Worlc Permit for subdivisions/large projecls <br /> COMMERCIAL Attacli(3)complete sets ofi Building I'lans�lus a Life Safety Page;(1)set of Cnorgy Form S orm at r Plans w/Silt Fence installed, <br /> Minimum ten(10)worlcing days after submittal date. Requir�d onsifie,Construction Plans, <br /> Sanilary f-acilities&1 dumpster.Site Woric Permil for all new projecls.All commercial requirements musl meet compliance <br /> SIGN PERMIT Attach(2)sets of Engineered Plans.� , <br /> "***PFtOPERTY SURVEY roqufred for all NEW construction. <br /> -I-f-1-I-I-I-1-1-1-FhH-i-I-I-I-FH-MI-I-I-I-I-1-1-1-1-H-i-I-1-I-i-1-t-H-1-FI-I-hi-I-l-I-I-H-M-1-I-1-f-1-I-I-1-I-I-1-I-1-1-I-I-I-1-W-1-hl-i-1-1-1-I-I-H-1-FI-1-i-1-1-I-l-I-I-I-}-f-id-H-hH-I-1-1-I-1-I-I-M-hl-1-H-I-hl-1-MI-I-f-I-i-hl-hi-f-i-1-1-h1-1-H-1-I• <br /> Directions: . • . <br /> Ffll out application completely. , . <br /> Owner&Conlractor sign bacic of application,notariz�d <br /> lf over�2500,a Notice of Comm�ncement is required. (AfC upgrades ov�r�5000) <br /> ** Agenl(for the contractor)or Power of Attorney(for the ownor)would be someone with notarized letter firom owner authorizinc�same <br /> •OVCR TIiC COUNTCl3.PLRMITTIN� (Fronl of Applicat(on Only) <br /> Reroofs Sewers Service.Upc�rades A/C �ences(I'loi/SurveylPootage) <br /> Driv�ways-Not over Counter if on public roadways.:needs ROW <br />