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- o��-,o„-��,�v ` ctry ot���in miits Permit�appiication �- � Fax-813-780-0021 <br /> B {Iding beparfinent ` <br /> ' , ��. - <br /> -. <br /> Date Rece�ved Phone Cont ct for Permlrting � <br /> �,�"'`� ��,�/�� <br /> Owner's M��e Own�r Phone Nutnber 3 �� v v c � r e'�`„�,_, <br /> Dwner's Addtess � �10 � �"4 A 2 f�-- � �/ Owner Phone Number � .—�� <br /> Fee Slmple Titleholder Name Owner Phone Number � � <br /> Fee Simple Titleholder Address � . -- — -- <br /> JUB ADDRESS � t U� , _ _ , _.. - r{�OT# � <br /> Y ~ .- <br /> 5U0DIYlSIUN �� � Pa CE9.ID�# <br /> __�.__ _ _ , - _ -- -------- -- --- -- - - - - - ------___ - - ldBTA1NED F'FtOM PR�DPEFt'TY TA1(NQTICE)_'y_ � _- -- - _ - - <br /> ; WORK PROP08ED e NEW CONSTR 8 AD /AL7 � SIGN Q Q DEMOLISH <br /> INSTALI RE AtR <br /> PROP08�D USE;' Q SFR [� CO M ['� 07HER <br /> FYPE OF CONSTRUCTION Q BLOCK [� F ME � STEEL Q <br /> DESCRIPTEQN t}F WORK L T'R �- 0 0 � <br /> �_� <br /> BUILDING SMZE � � SQ F007AC,�E NEIGHT ,, <br /> QBUILDiNG $ !) �.. C��y�� VALUAT ON OF T07AL.GONSTRUCTIQN <br /> ot <br /> QELECTRICAL $ AMP SE VICE [� PROGRESS ENERGY L] W.R.E.C. <br /> QPI.UMBiNG �6� .`'1 <br /> �� <br /> �]MECHANICAL $ VALUAT ON OF MECHANICAL INS7AI�LATION �� <br /> OGAS Q ROOFiNG � SF CIALTY �,� dTNER <br /> =1{ViSHED Fi.ObR ELEVATIOTdS ��� FL OD ZONE AREA QYES NO <br /> �, � � - <br /> 9UILQER � �COMPANY , ��G�,�y` r ` '�'s(�,1 �/�,,. <br /> 3Qi�sR�A�l�lRE r REGiSTERED Y! N FEE CURR�� Y/iV <br /> - Address Llcense# � � � <br /> cLEGTRICIAN COMPANY <br /> >lGNATURE REGISTERED Y/ N FEE GURRE� Y/N <br /> Address Ucense# �� � � <br /> aLUMBER � � COMPANY <br /> 31GNATUR� � REGlSTEREd Y/ N FEE Gt7RRE� Y/N <br /> Address License# �— �� <br /> AECtiANICAI COMPAtdY' <br /> ilGNATURE REGISTERED Y! N FEE CtlRREE Y!N <br /> 1 <br /> Address , Ucense# r� � <br /> )TH�R � COMPANY <br /> EIGNATURE REGIS7Ettea Y/ N F&E CURRER Y/N <br /> Addtess License# � ` � <br /> lEStDENT1AL Attach{2)Piot Ptans;(2}ssts of Buflding Pians;(1) et of Energy Forms;F2-O-W Permii far new constructtan, <br /> Minimum ten(10)wotking days after submitkal date. Requlred ansfte,ConstrucUon Plans,Stormwater Plans w!Silt Fence Instalfed, <br /> Sanitary Facliities&1 dumpster;Site Work Perrnit f r.subdivislonsAarge pro)ects <br /> :OMMERCfA! Attach(3)complete sets of Building A#ans plus a Cif Safety Page;(1)set af Energy Forms.R-O-W Permit for new constructton. <br /> Mtnimum ten{1Q)warking days after submitta!date. Required onsite,Constructlon Ptans,Storrrawater Ptans w!SITY Fence instalfed, <br /> Sani#ary Facllitles&1 dumpster.Site Work Permit f r ali new pra)ects.All commerclal requirements must meet compliance <br /> �lGN PEf{MIT Attach{2}sats of Engineered Ptans. <br /> `""•PROPERTI SURVEY requlred for all NEW con trucUon. _ <br /> �irections: <br /> F(II out applicaRtan completely. <br /> Owner 8 Contractor sign back of appllcation,natarixed <br /> If over$2500,a Notice af Commencement Fs required. (A!C u grades over�7500} <br /> ' ' Agent(for the contracfor)or Power of Attomey(for the owner)wou d be someone with notarized letter ftom owner_authorizing same <br /> � iVER TNE COUNTER PERM1TTi�SG {Front of Appflca�on Onty) -rv-,, , .��_�... ... °°.°° .._-�-,�., <br /> ;eroofs It shingles Sewers Serolce Upgrades A/C Fen es{PIaUSurvey/Foa#age} � . • „„� "'� ,'� :';�.���• = i <br /> A A' �r . ,.3 � .P <br /> Drivewayrs-Not over Caunfer if on pubflc roadways..needs ROW = _y;. , �° ��.�r . __ , - �� <br /> � ` '-' ,x ..- .,4: ...rrs..v. �rn.:i <br />