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���-,tl�-���� c:iry ot�ephymin Permit Application Fax-813-780-0021 <br /> Building epartment <br /> . <br /> Date Received� Phone Contact for ermittin � ��� -��� � <br /> Oeroners Rlame �/1 p/Z�� Ornrner Phone Number /�� �S�/� <br /> Oevner's Address �/ J �������.L� Oamer Phone fdumber <br /> Fee Simple Titleholder Mame Oamer Phone Rlumber <br /> Fee Simple Titleholder Address <br /> JOB 91DDRESS � � �S�a�7��I/.� � / ��/� �/� �3�`f� LOT# � <br /> SUBDIHISIOM �h�� �- �� PARCEL I # �3-��/0������d�l�l�� <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WOR7C PROPOSED B NEW CONSTR� ADD/ALT Q SIGIV Q [� DEMOLISH <br /> INSTALL REPAIR <br /> �ROPOSED USE Q SFR Q COMM � OTHER <br /> �YPE OF COMSTRUCTIOM Q BLOCK Q FRAME Q STEEL Q <br /> DESCRIPTIOR!OF HHORK l�'�� ���� �� ��� % � � <br /> BUILDIfdG SIZE SG!FOOTAGE HEIGHT <br /> �BUILDING $ VALUATION O TOTAL CONSTRUCTION <br /> QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C. <br /> QPLUMBING $ <br /> [�MECHARIICAL $ )''J�/� ueJ VALUATION O MECHANICAL INSTALLATION (� ���� � <br /> �/v�-'�' �' <br /> QGAS Q ROOFING Q SPECIAL Q OTHER � � �" V <br /> FIMISHED FLOOR ELEVATIONS FLOOD Z NE AREA QYES NO � ��G�j 7 <br /> l <br /> OUIL.DER COM A►MY <br /> SIGfdATURE REGIS RED Y/ IV FEE CURREA Y/N <br /> Address License# <br /> �LECTRICIAM COM ANY <br /> StGMATURE REGIS RED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> PLUIMBER COM ANY <br /> SIGMATURE REGIS ERED Y/ N FEE CURREt� Y/N <br /> E►ddress License# <br /> AIiECHARiICAI. � COM ANY ��./`��� G'Dl�� � Gi��G� <br /> SIGMATURE v REGI ERED Y/ N FEE CURRE� /N <br /> Address �O (ds � � ��� xfYV � License# <br /> OTHER COM ANY <br /> SIGtdATllttE REGI TERED Y/ N FEE CURRE� Y/N <br /> Address License# - - - <br /> RESIDE{dT1AL Athach(2)Plot Plans;(2)sets of Building Plans;(1)set o Energy Forms;R-O-W Permit for new construction, <br /> Mintmum ten(10)working days after submittal date. Re ired onsite,ConstrucUon Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities 81 dumpster,Site Work Permit for su divisions/large projects <br /> COMiMERCIAL Attach(3)complete sets of Buflding Plans plus a Life Sa ty Page;(1)set of Energy Forms.R-O-W Permit for new construction. <br /> Minimum ten(90)working days after submittal date. Re uired onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities 8�1 dumpster.Site Work Permit for all ew proJects.All commercial requirements must meet compliance <br /> SIGtd PERMIT Attach(2)sets of Engineered Plans. <br /> '"'"PROPERTY SURVEY required for all NEW consVuct on. <br /> Directions: <br /> Fill out application completely. <br /> Ovmer&Contractor sign back of application,notarized <br /> If over E2500,a Notice of Commencement is required. (A/C upgra es over a7500) <br /> •" Agent(for the contractor)or Power of Attomey(for the owner)would be sameone wlth notarized letter from owner authorizing same <br /> ONER THE COUNTER PERMITTING (Front of Application Only) <br /> Reroofs if shingles Sewers Serv(ce Upgrades A/C Fences( IoUSurvey/Footage) <br /> Drivevvays-Not over Counter if on pubiic roadways..needs ROW <br />� -- - ---- - - --- — - - <br />