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/ <br /> ���-,��-���� C:ity ot Zep yrhills Permit Application %Fax-813-780-0021 <br /> Buildfng Department � <br /> �' - <br /> Date Received Phone Coeptact for Permittin $�3 �$2.-=' ' 3 3 ��( - <br /> Owner's t�ame ry���ji �.Q J� � ej Owner Phone�lumber <br /> Owner's Address � 3 /� �L (,U , � Z,Q � Owner Phone Number <br /> Fee Simple Titleholder Name Owmer Phone Number <br /> Fee Simple Titleholder Address <br /> . � <br /> JOB ADDRESS �� I�1JIY� f/ L�i`) 'T 7(O LOT# � <br /> I SUBDIVISION � P�RCEL Ib# � --�- '�/�G�f �Q �j�G7 Gb4� <br />-- - --- _ - — - --r - --- - - - ---- ---- --(O@TdslMED FROf�!PROPERTY TAX-kOTICc)- - - , "- -- - -- <br /> NIIOR7C PROPOSED NEW CONSTR ADD/ALT Q SIGN Q Q DEMOLISH <br /> B INSTALL 8 R�PAIR <br /> PROPOSED USE Q SFR Q „COMM � OTHER <br /> TYPE OF CONSTRUCTIOId Q ' BLOCK ,Q FRAME Q STEEL Q <br /> DESCRIPTION OF VIIORK �Q , I �. �Io�rj (t <br /> � <br /> BUILDING SIZE SQ FOOTAGE � ' HEIGHT <br /> QBUILDING $ VALU TION OF TOTAL CONSTRUCTION <br /> � ELECTRICAL .$ �� AMP S RVICE��3 Q PROGRESS ENERGY � W.R.E.C. <br /> QPLUMBING $ �U�� <br /> Za2��o2 <br /> QMECHANICAL $ VALU ION OF MECHANICAL INSTALLATION ,A A ���(i�/C � <br /> � `�v6 / <br /> QGAS Q ROOFING Q SPECIALTY Q OTHER ���5 <br /> FINISHED FLOOR ELEVATIONS F OOD ZONE AREA QYES NO � 1 <br /> BUILDER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address � License# <br /> ELECTRICIAN � � COMPAMY � '`/1,(��" �� <br /> SIGlVATURE � REGISTERED / N FEE CURRE� /N <br /> Address _ � � ! � License# � � (�U� ���p <br /> � " i <br /> � <br /> PLUMBER COMPANY <br /> SIGNATURE - REGISTERED ' Y/ N FEE CURRE� Y/N <br /> Address License# <br /> MECHANICAL COMPANY <br /> SIGMATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# � � � <br /> OTHER COMPANY <br /> SIGMATURE REGISTERED Y/ N FEE CURRE� Y/N I <br /> �lddress License# �— I <br /> i <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 dat . Required onsite,Construction Plans,Stormwater Plans-w/Silt Fence installed, ' <br /> Sanitary Facilities 81 dumpster;Site Work Permi for subdivisions/large projects <br /> COMINERCIAL Attach(3)complete sets of Building Plans plus a ife Safety Page;(1)set of Energy Forms.R-O-W Permit tor new construction. <br /> Minimum ten(10)working days after submittal dat . Required onsite,Construction Plans,Stormwater Plans w/S(It Fence installed, <br /> Sanitary Facillties&1 dumpster.Site Work Permi�for all new proJects.All commercial requirements must meet compliance <br /> SIGN PERMIT ABach(2)sets of Engineered Plans:, <br /> •"'PROPERTY SURVEY required for all NEW corstructlon. <br /> Directions: I <br /> Fill out applicatlon completely. <br /> Owner&Contractor sign back of application,notarized , <br /> if over 52500,a Notice of Commencement Is required. (AIC pgrades over�7500) � <br /> •' Agent(for the contractor)or Power of Attomey(for the owne[)w uld be someone wlth notarized letter'from owner authorizing�same„- <br /> OVER THE COUNTER PERMITTING ;,✓,. -,(Front of Application Qnly� . , ,., ,- :, , ,, . ; : : `= , ` <br /> Reroofs if shingles Sewers:;:- , Service<Upgrades:A%C :"'�Fe ces(Piot/Survey/Footage) _ z„� _ _ ,. . _ - � - " - <br /> ;j ;t ' - . � • . „ � , ' . <br /> Driveways-Not over Counter(if_on public roailway�,.needs ROW •� �� °�°-_° �_�--T� - -�� «._._ -_ ,-, <br /> I <br /> I <br /> I <br />