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�.`! / ,�Y� -� ,.�:t ,,.�n•'�n'�n+^� -.�-°'?�-70�nn�. <br /> 813-780-0020 r;' � C� [.Pi-J. .,:� -�"r :ln��.. c .. . _ <br /> =�,��i�lin:i Di�p�rtiient <br /> Date Received Phone Coritact fi:�r P��rmittin�i� I� _� -- <br /> miraan=��m�m'�i xi�r <br /> Owner's Name _ �_.__� '����er I'hc��e Wumber <br /> — — -----� <br /> Owner's Address ___._� ���ner Nhe�ne Number <br /> � Owne�r Phoirte Number � <br /> Fee Simple Titleholder Name � _____J <br /> Fee Simple Titleholder Address _— _ _— <br /> JOB ADDRESS - -- LOT# �� <br /> SUBDIVI510N � PARCEL�D#C_ <br /> (OESTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED e NEw CONSTR 8 ADD/ALT � SI��N Q Q DEMOUSH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SFR Q COMM � OIfHER <br /> TYPE OF CONSTRUCTION Q BLOCK Q FRAME 0 Sl'EEL Q <br /> DESCRIPTION OF WORK <br /> BUILDING SIZE SD FOOTAGE C� HEIGHT <br /> �BUILDING $ VALUATION OF TOTAL CONSTRUCTION <br /> �ELECTRICAL $ AMP SERVICE 0 PROGRESS ENERGY Q W.R.E.C. <br /> QPLUMBING $ <br /> OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION <br /> �GAS Q ROOFING Q SPECIALTY � OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO <br /> BUILDER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> ELECTRICIAN COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address 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 I N <br /> License# <br /> Address <br /> OTHER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> License# � <br /> Address - <br /> RESIDENTIAL 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. Required onsite,Constructfon Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities 8 1 dumpster;Site Work Permit for subdivisions/large proJects <br /> COMMERCIAL Attach(3)complete sets of Buiiding Pians plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction. <br /> Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities&1 dumpster.Site Work Permft for all new projects.Ali commercial requirements must meet compliance <br /> SIGN PERMIT Attach(2)sets of Engineered Plans. <br /> `•"'PROPERTY SURVEY required for all NEW consWction. <br /> Directions: <br /> Fill out application completely. <br /> Owner&Contractor sign back of appBcation,notarized <br /> If over 52500,a Notice of Commencement is requfred. (AIC upgrades over 57500) <br /> " Agent(for the contractor)or Power of Attomey(for the ovmer)would be someone with notarized letter from ovmer authorizing same <br /> OVER THE COUNTER PERMITTING (Front of AppHcatlon Oniy) <br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoVSurvey/Footage) <br /> Driveways-Not over Counter if on public roadways..needs ROW <br />