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:�_ . <br /> Buildfng D partment Ze-�� Y 1�r�ll S <br /> a� <br /> Date Recelved, _2 �� <br /> � Phone,Contact for P., rmittin �t 3 - - (�; <br /> Owner's��Name�°' � '_ 1'Z� �q�!r1 q S � 1 Owner Phone Numb r g 13-3 J 2 = ��3 2 <br /> � <br /> Owners Address 3 g`�p Owner Phone Numb r <br /> � <br /> � <br /> Fee Slmple Titleholder Name i Owner Phone Numb r <br /> � <br /> Fee 3lmple Titleholder Address ; � <br /> JOBADDRESS � �� I �� v�Q_ ��j� �,�\\� FL, '3 j" '7� LOT# 12 -� i 3 <br />� � <br /> � n � <br /> SUBDIVISION Ci"ty rry-�Q(���1\S PARCEL ID# I -� °Z� ' d�� ' 1 �QQ '(, '�O <br /> � (OBTAINED FROM P OPERTY TAX NOTICE) <br /> WORK:PROP03ED NEW CONSTR ADD/ALT SIGN [� �] DEMOLISH <br /> B INSTALL 8 REPAIR <br /> PROPOSED.USE Q.� SFR Q COMM OTHER <br /> TYPE OF CONSTRUCTION Q i BLOCK Q FRAME STEEL Q <br /> ,��i,^ <br /> DESCRIPTIONOFWORK f�G"�ACQ� � " � � `"i' S:Z�ISi �=L 'fobp��.s <br /> T=L..`�q IZ�ial .S <br /> 9UILDING SIZE ; SQ FOOTA(iE� HE�GHT' <br /> QBUILDIN(3 $ , I ,�� VALUATION OF T TAL CONSTRUCTION <br /> � <br /> QELECTRICAL $ ; AMP SERVICE Q PROG ESS ENERGY Q W.R.E.C,. <br /> � � <br /> [�PLUMBING $ ' [n� <br /> i .��e <br /> QMECHANICAL $ VALUATION OF M CHANICAL.INSTALLATION 4 <br /> . � <br /> OGAS Q ROOFING Q SPECIALTY OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE REA �]YES NO <br /> � G C.�,e-� .L-�' <br /> BUILDER "" `�nn� �� ��OMPAN �ow-eS ldoM�, Ce�7�2s �n/�� <br /> SIGNATURE 'L�/�� �� � REGISTERE Y/ N FE CURRE� Y/N <br /> Address O QOl� � d�✓ ��A��cy 3Y-$7�' Licens # .�ro� .S(� � � <br /> ELECTRICIAN COMPAN <br /> SiGNATURE RECaISTERE Y/ N FE CURRE� Y/N ; - <br /> Address Licens # <br /> PLUMBER � COMPAN � � <br /> 51GNATURE REGISTERE Y/ N FE CURRE� Y/N - <br /> Address Llcense# � ! <br /> :i <br /> MECHANICAL COMPA <br /> 51GNATURE REGISTERE Y/ N FE CURRE� Y/N ,` � <br /> Address � I Lfcense# <br /> � <br /> OTHER COMPAN I <br /> 31GNATURE REGISTERE Y/ N - Fe CURRE� Y/N : <br /> i <br /> Address � Lfcense# <br /> 4ESIDENTIAL Attach(2)Plot Plans;(2)sets of Bullding Plans;(1)set of Ener y Forms;R�O-W Permit for ew constructlon, <br /> Mlnimum ten(10)wo'rking days after submittal date. Requlred nsite,Constructlon Plans,S ormwater Plans wl Silt Fence installed, <br /> Sanitarv:FaciilUes 81 dumpster,Sfte Work Permit for subdivisi nsAarge.p♦ro�ects <br />--;,�NiiYiERCf/�L -Attach(3)�mplete sats-of�Buflding Plans�p�us a`L!fe Saf3ty PQ O��t�-�JE[�VE�iiergy-Fonn�.- -O=VIi�Pem:lt=for-�ew-constructlon::-�__- -_ _..: <br /> Minimum ten(10)working days after submfttal date. Required nsite,ConstrucUon Plans,S ormwater Plans w/Silt Fence-installed; <br /> Sanitary Facilities 81 dumpster.Site Work Permit for all new pr jects.All commerclal requir ments must meet compllance <br /> 31GN PERMIT Attach(2)sets of Englneered Plans. i <br /> """PROPERTY SURVEY requlred for all NEW construction. <br /> )irections: <br /> Fill out appNcatfon completely. <br /> Owner&Contractor sign back of application,notarized <br /> If over 52500,a Notice of Commencement is requlred. (AIC upgrades ov r a7500) <br /> • Agent(for the contractor)or Power of Attomey.(for the ownet)iNould be someo e with notarized letter from owner authorizing same <br /> )VER THE COUNTER PERMITTING � - (Front of Application.Only;) <br /> Seroofs ff shingles Sewers Service Upgrades A/C Fences(Plot/Su ey/Footage) <br /> Driveways-Not over Counter if on public roadways..needs ROVV <br />