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813-780-0020 Gi�ly o���epnyrnn►s ,�c;tl�u�r�NN���au�„ • <br /> � Building Department <br /> Date Receivad ��� ���. _ S3� <br /> Phono Confact for I'ermitting �- , / <br /> -rrrrrrrri-rr�N-rr-- - - -- - -- - - - - -- --- y-ri-�-►-ri-� - rrr �-+-�-� -�F-rri-i+itr-rrri-r <br /> Owner's Name "(� ��'�"��� • Owner Ahone Number d'�3� 997—'�yDy � I <br /> Owner's Address �37,33�0 �@! d/if' P�+�-�� owner Phone Numuer <br /> f-'ee 5imple Tifieholder Name • Owner Phone Nurriber <br /> Pee Simple Titleholder A�dress <br /> JOI3 ADDRGSS �3 7 33�o� ��� � Ors / Q�� • ' LOT�� � <br /> 5UI31]IVISION � • PARCGL If]# ��— a-� —�"����d— �s�� � �}"— <br /> . (013TAINED FROM PROPERTYTAX NOTICE) <br /> WORK PROPOSCD ' NCW CONSTR ADD/ALT 0 SIGN 0 11AOVE Q DEMOLISI-I <br /> � INSTALL • • � REf'AIR <br /> PROPOSED USE' • 0 <br /> SI=R ' �� • COMM � OThICR <br /> TYPC O�CONSTRUCTION � aLOCK � FRAME ' .0 STCEL 0 OTHER <br /> DCSCRIPTION OF WORK � d C �� <br /> BUILDING SIZG �T X �v SQ(=00TAGC � I-IC[G(-IT <br /> 13UILDING � �O � VALUATION 01=TOTAL CONSTRUCTION , <br /> � ELECTI�ICAL :G , AMP SCRVIC[ 0 PROGRESS EN6RGY • � W.R.E.C. <br /> , . . ��37 <br /> 0 PLUMBING �� F'A�CO PERMIT SERV <br /> . ' (813)788- <br /> 0 MCCI-IANICAL $ � VqLUATION Ol=MECHANICAL INSTALLATIOI�,F�1 -7894� <br /> � <br /> CAS 0 ROOFING [� SPECIALTY 0 OTHCR , � f/ � v <br /> f=1NISl-IED FLOOR CLEVATIONS PLOOD ZONE AREA �YES [� � �,�� <br /> 13UILDCR ` �/�� „ `/- , ������ COMPANY ��U /'� ' /,/� �n <br /> SIGNATURG b`'���'�v f2EGISTERHD Y/ N F- URRGNT Y I N <br /> Address 3 73`� /�l /tf C7'� ' . License� l_.l�C UJ��� <br /> 6LCCTRICIAN • COMPANY <br /> SIGNATURC REGIS7GRE� Y/ N FCE CURRCNT Y/N <br /> � - Lic�nse# <br /> Address <br /> PL,UMBL-R . � COMPANY <br /> 51GNATURL- RGGISTERED Y/ N FGG CURRENT Y/N <br /> � License# I <br /> Add�ess <br /> MECI-IANICAL ' COMPADIY <br /> SIGNATUR� • RE�IST6Re� Y/ N FEE CURR[NT Y I N <br /> .License# � � <br /> Address • ' . <br /> OThlCR • � COMPANY ' <br /> SIGNA'I'URG RCGISTERED Y/ N �HC CURRENT Y/N <br /> Address � , License# � <br /> RC5ID�NTIAL Attach(2)Plot'Plans;(2)sets of Duilding Pians;(1)seY of Energy Forms;R-O-W Permlt for new construction, <br /> Minimum ten(10)worlcing days after submit�a!date. Required onsite,Construction Plans;Stormwater Plans w/Siil•Fence installed, <br /> Sanitary f-acil(ties&1 dumps#er,Site Worlc Permit for subdivisions/large�rojects <br /> COMM[RCIAL: Attach(3)complete sets of Building Plans�lus a Life Safety Page;(1)set of Cnergy 1=orms.R-Q-W Permit for new construction. <br /> Minimum len(10)worlcing days after submittal date. Requir�d onsite,Construction Plans,Slormwater Plans w/Sill Fenco installed, <br /> Sanilary 1=acilifiies&1 dumpsier.Site ullorlc Permil for all new projec[s.All commercial requiroments must meel compliance <br /> ' SIGN I�ERMIT Attach(2)sets of Engineered Plans.� . <br /> ****PROPERTY SURVEY roquired for all NEW construcUon. <br /> -f-I-I-I-I-H-}-hH-H-I-I-I-1-hl-I-FI-hH-1-1-1-I-I-1-1-1-1-1-1-Idi-H-I-hH-H-l-H-1-H-I-1-(-1-hhl-1-I-H-I-1-I-h1-I-hI-I-W-I-1-1-1-1-I-1-1-I-H-1-Fl-I-1-1-1-I-1-hl-f-1-1-1-hH-1-H-I-I-1-H-I-I-I-i-1-1-I-l-1-1-I-1-hl-hl-l-l-li-1-H-I-I-H-Fhl-H-1-H <br /> DirocEions: . . , <br /> Flll out application comploLely. , <br /> Owner&Con[ractor sic�n bacic of application,notarized <br /> If over$2500,a Notice of Comm�ncement is requirecl. (A1C unc�rades over�5000) <br /> ** Agent(for the co,ntractor)or Power of Attorney(for the owner)would be someone with noYarized letter from owner authorizinc�same <br /> •OVCR TIiE COUNTCR PERMITTING (f=ront of A�plication Only) � <br /> Reroofs ' Sewers Sorvice.Upc�rades A/C 1=ences(Plot/Survey/l=ootage) <br /> Driveways-Not over Counter if on public roadways.:needs FtOW <br />