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-�- -- ---� �.��y u� ��pnyrnins rermit Hppncation Fax-813-780-0021 <br /> Building Department <br /> Date Rec�ived .� � <br /> Phone Contact for Permittin -_ <br /> Owner's Name �� .S �2.�t /, i � Owner Phone Number <br /> Ovmer's Addresa ,3� � � ,IJ /C � Owner Phone Number <br /> Fee Simple Titleholder Name —� Owner Phone Number <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS � /I '�S � � LOT# �� <br /> SUBDIVISION � —� PARCEL IDM �a'�b -�-� -Qp Q -O�p p J � QC��fl <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> VVORK PROPOSED NEW CONS7R ADD/ALT � SIGN Q Q DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE SFR Q COMM � OTHER <br /> 1rVPE OF CONSTRUCTION BLOCK Q FRAME � S7EEL Q <br /> DESCRIPTION OF WORK �; <br /> BUILDING SIZE �—� 3Q FOOTAGE � HEIGHT <br /> . BUILDING $ ' '7/ , G'31 VALUATION OF TOTAL CONSTRUCTION <br /> �'�O V <br /> QELECTRICAL $ AMP SERVICE O PROGRESS ENERGY Q W.R.E.C. <br /> QPLUMBING $ � ��.�e��.e�� <br /> QMECHANICAL a VALUATION OF MECHANICAL INSTALLATION 2 ) !v(iC,� <br /> OGAS Q ROOFING Q SPECIALTY � OTHER `✓ Z �d �G�� <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO � CL/CI� <br /> r�s� � <br /> BUILDER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# r <br /> ELECTRICIAN COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Add►ess 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 J N <br /> Address License# <br /> OTNER w� � 1 • � � � „ ��COMPANY ! �� I� /� � <br /> SIGNATURE �-� (. � REGISTERED Y/ N FEE CURRE� Y <br /> Address :.3�7,� C o/`Q �= License# CC C -G � <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Pertnit for new construction, <br /> Minimum ten(10)working days after submittai date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilitfes&1 dumpster;Site Work Permit for subdivisionsllarge projects <br /> COMMERCIAL Attach(3)complete sets of Building Plans plus a Ufe Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction. <br /> Minimum ten(10)working days after submittal date. Requlred onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities 8�1 dumpster.Site Work Permft for all new projects.All commercial requirements must meet compliance <br /> SIGN PERMIT Attach(2)sets of Engineered Plans. <br /> •"""PROPERTY SURVEY required for all NEW construcUon. <br /> Directtons: <br /> Fiil out application completely. <br /> Ovmer 8 Contractor sign back of applfcaUon,notarized <br /> If over 52500,a Notice of Commencement la required. (A/C 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 /> 01/ER THE COUNTER PERMITTING (Front of Applicatlon Only) <br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage) <br /> Driveways-Not over Counter if on public roadways..needs ROW <br />