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-'- ""' ""' �.ny c,� c.epnyrn�ns rermi[Hppncat�on Fax-813-780-0021 <br /> Building Department <br /> Date Received A •- �'1�.� �� � � _ <br /> �� Phone Contact for Permittin D <br /> Owner's Name �� , /y[QiC. /y!J - pvyner Phone Number �3� /G "'7G/� <br /> Owner's Address (O 29 Q� • �! �i n� 3 Z-Owner Phone Number �— <br /> Eee Simple Titleholder Name <br /> Owner Phone Number <br /> Fee Simple Titleholder Addresa <br /> JOB ADDRESS (O 3Z �!d` � � /�`f• 33S¢Z � <br /> LOT# __�� <br /> SUBDIVISION PARCEL ID# <br /> (OBTAINED FROM PERTY TAX NOTICE) <br /> MIORK PROPOSED e N TALLSTR 8 REP AR � SIGN � Q DEMOLISH <br /> PROPOSED USE Q SFR Q COMM � OTHER <br /> �VPE OF CONSTRUCTION C] BLOCK [� FRAME [� STEEL Q --� <br /> DESCRIPTION OF WORK /N�AGL �,,i t"�' ��J L,+/� '�/ <br /> BUILDING SIZE SQ FOOTAGE C] HEIGNT <br /> QBUILDING $ <br /> 2�2,�C , �}L VALUATION OF TOTAL CONSTRUCTION <br /> QELECTRICAL �� AMP SERVICE O PROGRESS ENERGY �] W.R.E.C_ <br /> QPLUMBING $ <br /> QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION <br /> QGAS Q ROOFING Q SPECIALTY �� OTHER <br /> FINISHED F�OOR ELEVATIONS FLOOD ZONE AREA QYES NO <br /> BUILDER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> �LECTRICIAN ) l^������ � ' ► COMPANY � ���/1� s�'/CV'(.�',�iUC <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address �I' � ��(r�A rC �i c.= ��� �u�i-� 3 yd� �icense# �C�.�0 U 317D <br /> PLUMBER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURREP Y/N <br /> Address License# � <br /> MECHANICAL COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# �— —� <br /> OTHER COMPANY <br /> SIGMATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# �— ��� <br /> RESIDENTIAI Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction, <br /> Minimum ten(10)working days after submittal date. Requfred onsite,Constructfon Plans,Stormwater Plans w/Silt Fence instalted, <br /> Sanitary Fadfltles 8 1 dumpster;Site Work Pertnit for subdivfsions/large projects <br /> COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Pertnit for new construction. <br /> Minimum ten(10)worlcing days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Siit Fence installed, <br /> Sanitary Facilities 8 1 dumpster.Site Work Permit for all new proJects.AII commercial requirements must meet compliance <br /> SIGN PERIVIIT Attach(2)sets of Engineered Plans. <br /> '""`PROPERTY SURVEY required for all NEW constructlon. <br /> Directlons: <br /> Fill out application completely. <br /> Owner&Contractor sign back of appHcatlon,notarized <br /> If over 52500,a Notice of Commencement is required. (A/C upgrades over ST500) <br /> "' Agent(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same <br /> OVER THE COUNTER PERMITTING (Front of Applicallon 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 />