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es��-iou-uu�u c;iry ot�epnymin Permit Application Fax-813-780-0021 <br /> Building Department <br /> a <br /> Date Re�;eieed Phone Contact tor Permtttin -- <br /> Owner's Mame �//C]1�� � � �n��z� Ovuner Phone Idumber U��'��69��/�(° , <br /> �vner's Address /��J i Oamer Phone Idumber � <br /> Eee Simple Titleholder Mame Owner Phone Idumber <br /> Eee 5imple Titleholder Address <br /> JO�ADDRESS ���� LOT# �� <br /> SUBDINISIOfd PARCEL D# �°�'�b%7��d�a�o��'vb ao z a <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> MfOEtEC PROPOSED NEW CONSTR ADD/ALT Q SIGN Q Q DEMOLISH <br /> B INSTALL � REPAIR <br /> �EtOPOSED USE Q SFR Q COMM � OTHER <br /> 'TYPE OF COIdSTRUCTIOtd Q BLOCK Q FRAME Q STEEL Q <br /> pESCRIPTIOId OF HHORK /�/� l� � �r��5��� � LCi vrl i?"r✓T o��G��� � � <br /> �UILDIRIG SIZE SQ FOOTd►GE HEIGHT i <br /> QBUILDING $ VALUATION F TOTAL CONSTRUCTION � <br /> QELECTRICAL $ AMP SERVIC Q PROGRESS ENERGY Q W.R.E.C. <br /> OPLUMBING $ I <br /> . 5� � � <br /> �MECHARIICAL $ /�y� [�O VALUATION F MECHANICAL INSTALLATION "�� , <br /> (/L/. �, <br /> QGAS Q ROOFING Q SPECIAL � OTHER � �I�/� <br /> FINISHED FLOOR ELEVATIONS FLOOD Z NE AREA QYES NO � � I <br /> BUI�.DER COM ANY � <br /> SIGMATURE REGI RED Y/ fV FEE CURRE� Y/N � <br /> e4ddress License# I <br /> ELEC'TRICIAM COM AMY � <br /> SIGIde4TURE REGI RED Y/ N FEE CURRE� Y/N ' <br /> Add�ss L(cense# � <br /> PLUMB�R COM AtdY <br /> SIGfdATURE REGI TERED Y/ N FEE CURRE� Y/N � <br /> c4ddress Ltcense# <br /> A�IECHAMICAI. ��,,� r r CO�A ANY d�"��S � p/.�.:/� �P.0�"1g�rlJCX� <br /> SIGMATURE REGI TERED N FEE CURRE� /N <br /> Address /o�"� us�a� ,����r�- ���� �s License# �`7 CO�-� <br /> OTHER CO PANY <br /> SIGMATURE REGI TERED Y/ N FEE CURRE� Y/N � <br /> Address License# � <br /> RESIDE(dTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set o Energy Forms;R-O-W Permit for new construction, � <br /> Minimum ten(10)working days after submittal date. Re uired onsite,Construction Plans,Stormwater Plans w/Siit Fence instailed, <br /> Sanitary Facflities 81 dumpster,Site Work Permit for su divisionsAarge proJects <br /> COIIAfME1tC1AL Attach(3)complete sets of Building Plans plus a Life Sa ty Page;(1)set of Energy Forms.R-O-W Permit for new constructfon. <br />-- - Minimum ten(10)wrorking days after submittal date. Re uired onsite,Construction Pians,Stormwater Plans w!Silt Fence installed, <br /> I Sanitary FaclHties&7 dumpster.Site Work Permit for all ew projects.All commercial requirements must meet compliance <br /> SIGfd PERMIT Attach(2)sets of Engineered Plans. <br /> "'•PROPERTY SURVEY requ(red for all NEW consUuct on. ; <br /> Directions: - � <br /> Fill out appltcation completely. <br /> Oumer&Contractor sign back of application,notarized <br /> If over SZ500,a Motice of Commencement is required. (AIC upgra es over�7500) <br /> '• Agent(for the conVactor)or Power of Attomey(for the owner)would be sameone with notarized letter from owner authorizing same <br /> OdER THE COUNTER PERMITTIMG - _ -(Front.of ApPlication Only) <br /> Reroois if shingles Sewers i _', ' Service.Upgrades A/C�° Fences( lot/Survey/Footage) <br /> _, ,, <br /> Driveviraays-Not over Countei if'on putilic roadways..needs,R01N <br />