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- <br /> � <br /> � �' aais-7ao-oozo Cit of Ze h rhills �ermit A lication Fax-813-780-0021 <br /> Y P Y � PP <br /> Building Department <br /> Date Received Phone Contact for Permitting <br /> Owner's Name �'�,`�'�� . � � !1���� Owner Phone Number �l 3 �8 3- �3�S <br /> Owner's Address /�P� ���"��� �`�� Owner Phone Number <br /> Fee Simple Titleholder Name Owner Phone Number <br /> „ I <br /> Fee Simple Titleholder Address • <br /> JOB ADDRESS —!LI �o w� 5*e'C� �V�" c.�C'��� LOT# � <br /> SUBDIVISION �/v�� (/U r �, �.�c7 PARCEL ID# � �o`'� ' � �V•lJC.1l.�JV•� J C� <br /> J (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED NEW CONSTR ADD/A�T Q SIGN � MOVE � DEMOLISH <br /> � INSTALL B REPAIR <br /> PROPOSED USE � SFR � COMMI Q OTHER <br /> ' TYPE OF CONSTRUCTION �/ BLOCK Q FRAM� Q STEEL Q OTHER <br /> DESCRIPTION OF WORK ��� 7 0� 13 �.�r �'�r 14� �� C�(�� <br /> BUILDING SIZE SQ FOOTAGE HEIGHT <br /> _. � - - -- <br /> � BUILDING $ VALUATION OF TOTAL CONSTRUCTION <br /> Q ELECTRICAL $ AMP SER�ICE � PROGRESS ENERGY Q W.R.E.C. <br /> Q PLUMBING $ �Pr�,� <br /> � � ,/ b 1� <br /> MECHANICAL $ )���� D p VALUATIO OF MECHANICAL INSTALLATION � ` �Q � <br /> �' 4 � �` �� <br /> 0 GAS Q ROOFING 0 SPEC�ALTY 0 OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOp ZONE AREA QYES QNO <br /> I <br /> ��. ��,� ��:�:��, . � �,. <br /> BUILDER CIOMPAPJY <br /> SIGNATURE REGISTERED Y/ N FEE CURRENT Y/N <br /> i <br /> Address I License# <br /> ELECTRICIAN COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRENT Y/N <br /> I <br /> Address I License# <br /> I <br /> PLUMBER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRENT Y/N <br /> I - <br /> Address �— � I 1 License# � <br /> MECHANICAL � � � � IOMPANY '� � � <br /> SIGNATURE �/ �EGISTERED Y/ N FEE CURR NT Y/,N <br /> Address J U� �0� ��� � �l�. I License# ', ) Z <br /> I <br /> OTHER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRENT Y/N <br />� Address I License# <br /> � <br /> - rm" - <br /> i <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms <br /> IVlinimum ten(10)working days after submittal date. Required onsite,Construction Plans,Sanitary Facilities&1 dumpster <br /> COMMERCIAL Attach(3)sets of Building Plans;(1)set of Energy Forms. <br /> Minimum ten(10)working days after submittal date. Req�ired onsite,Construction Plans,Sanitary Facilities&1 dumpster <br /> All commercial requirements must meet compliance. <br /> SIGN PERMIT Attach(2)sets of Engineered Plans. <br /> '*"PROPERTY SURVEY required for all NEW constructivn. <br /> �.�ne u� ��nF�� — ra oa �r'>Fr �v ��§��°�'a� .l�a .— ��an�:r�€�a i �w , c w :�m�w�, � a^.on^�•s x <br /> Directions: <br /> Fill out application completely. <br /> Owner&Contractor sign back of application,notarized <br /> If over$2500,a'Notice of Commencement is required. (A/C upgrades over$5000) <br /> *' Agent(for the contractor)or Power of Attorney(for the owner)would be so eone with notarized letter from owner authorizing same <br /> OVER THE COUNTER PERMITTING (Front of Application Only) <br /> Reroofs Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage) <br /> Driveways-Not over Counter if on public roadways..needs ROW <br /> I I <br />