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�,s-�nu-uuzu c;ity ot[ephymills Permit Application Fax-813-780-0021 <br /> Building Department <br /> Date Recetved � '� � l C> (J - <br /> Phone Contaat for Permittin <br /> O�nrne�'s fdame Owner Phone Number �) ' 'f� " <br /> Odvner's Addresa � Owner Phone Number � � 3 �-� �D -(iJ 3�S <br /> Fee Slmple Titleholder IVame , ' Owner Phone Number <br /> Fee Simple Tttlehoider Address <br /> JOB ADDRESS .�� � � � LOT S { n'� '� <br /> SUBDNISION J• VQ�G�d PARCEL ID# " �' <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED B NEW CONSTR� ADD/ALT Q SIGN [� C] DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SFR � COMM � 07HER <br /> '1rXPE OF CON3TRUCTIOId Q BLOCK � FRAME Q STEEL Q <br /> - �. . <br /> pESCRIPTION OF MIORK � � <br /> BUILDIM(3 SIZE SQ FOOTA(iE-��� HEIf3HT <br /> BUILDING � I�� ��� ��1'_, VALUATION OF TOTAL CONSTRUCTION <br /> � <br /> QELECTRICAL ($� AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C. <br /> �— /� '---�-.. <br /> QPLUMBING S �v �''f ��� ' <br /> s' - ��-� �� .. <br /> QMECHANICAL S VALUATION OF MECHANICAL II�Sfi1�LLATION �"'"�"t ''� �y� <br /> �;,�� ,--�' <br /> QGAS Q ROOFING Q SPECIALTY �{''� OTH � � <br /> FIfVISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YE$ NO <br /> � i � <br /> BUILDER COMPANY C � <br /> SIGMATURE I�' REGISTERED Y/ N FEE CURR Y/N <br /> Addross �i,_bt�l �'� 11� � � � License# �11� • � I�� <br /> �LECTRICIAN COMPANY <br /> SIGMATURE �' �' REGISTERED Y/ N FEE CURRE� Y/N <br /> Address ��JK � License# G l:l/V � <br /> PLUMBER COMPANY <br /> SIGNATURE /V� REGISTERED Y! N FEE CURREI. Y/N <br /> Addreas � �� l)1�t1 Ltcense# _,t'l ,1!��I'c Jv" 1 I <br /> AAECHANICAL � COMPANY CC � � � � � <br /> SIGNATURE REGISTERED Y/ N �E REn Y/N <br /> Address l,�� � � 3� Lfcense# li <br /> OTHER COMPANY � � � � �� <br /> SIGMATURE �/�,J REGI3TERED Y/ N FEE CUR Y J N <br /> Address �� � . 1'tUS `1� � � License# � � li/ <br /> RESIDENTIAL Attach(2)Plot Plans;(2)seb of Building Plans;(1)set of Energy Fortns;R-O-W Pennit for new constructfon, <br /> Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater P�ans w/Silt Fence instatled, <br /> Sanitary Facilities 6 1 dumpster;Site Work Permit for subdivisionsAarge projects <br /> COMMERCIAL Attach(3)complete sets of Building Plans plus a LNe Safety Page;(1)set of Energy Forms.R-O-W Permit for new constructfon. <br /> Minimum ten(10)working daya after submittal date. Requlred onsite,Construction Plans,Stormwater Plans w!Silt Fence installed, <br /> Sanitary Facilitfes b 1 dumpster.Site Work Permit for all new proJects.All commercial requirements must meet comp8ance <br /> SIGM PERMIT Attach(2)sets of Engineered Plans. <br /> •"•'PROPERTY SURVEY requlred tor all NEW constructlon. <br /> Directiona: <br /> Fill out appi(cation completely. <br /> Ovmer 8 Contractor stgn back of applicaUon,nota�lzed <br /> If over 52300,a Notice of Commencement is required. (A/C upgtadea over 57500) <br /> •• Agent(for the contractor)or Power of Attomey(for the owner)would b�someone wfth notarized letter from owner authorizing same <br /> ObER THE COUNTER PERMITTING (Front of Applicatlo�Only) <br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage) <br /> Driveways-Not over Counter if on publ(c roadways..needs ROW <br />