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� � <br /> s�3aso-oo2o City of ephy�hjtlslPermi#Appticatian Fax-813-780-0021 - <br /> , � Bui�cling Department <br /> � <br /> . ' <br /> Date Rece ved � i <br /> B�aan Cantact fcr Perm�tting -- <br /> Owner's Name � � i . Owrner Phone Mumber �" 7 —✓' <br /> }' i t � <br /> Obrner's Address ��G -I�/ � . P' i, �Ij�wner Phone Number �� <br /> � <br /> Fee Simple Titieholder Name � ,.., . � Owner Phone Number � � <br /> ! <br /> Fee Simple Titlehalder Addres� { <br /> JOB ADDRESS �M t q/S J �J��� Y � � <br /> �'° r.- LOT# <br /> ! /'}q f} (�ff(} /'� �} <br /> SUBDIlLtSiON (! �f� /�d PARCEI 1D# �� ���tlo` LY�!l�`✓� ��°Jc�-:J <br /> =- - ----.--�- _. �- , ----- -- -�_- - - _ __ .`__ __.L---___� . (09TP.1ldED FROhN PROPERTY-RAX-NUTICE) - ___..T __.. -- -- <br /> NlICtR�t PRt1PdSED e � NEW CONSTR 8 ADDIAl�T SlGN Q [,� .DEMQ�.ISH �' <br /> INSTALL REPAIR <br /> �RQPQSEDUSE Q SFR Q COMM;- ' � OTNER <br /> TYPE OF GONSTRUCTIOM Q BLOCK Q FRAME � STEEL Q <br /> DESCRIPTION OF WORK it [�(/, �// �n/► ��I��n f� � n�"') ��'��'`� ��+�^ <br /> BUIL.t�tNfi SiZE $Q FOOTA E � HEIGHY � <br /> QBUI�DING �� � �,uATIORt OF TOTAL CONSTRUCTION <br /> QE�ECTRICA� �� A P SERVlGE Q_ PRQGRESS ENEFtGY [� W.t2.E.C. <br /> QP�.IlIt+1811dG [�> i ' �;�'��j <br /> L � ,y � <br /> ECHANICAL $ V L.UATION QF MECHANICAL INSTALIATIQt� $� <br /> QGAS Q I200FING Q SPECIALTY Q OTHEf� <br /> FINISHED FLOOR ELEVATIONS � � FLOO[7 ZONE AREA QYES NO <br /> i <br /> I <br /> � <br /> i <br /> �. _BUII.�ER . - -- - - -- - - --��MP,4RtY- _ - - - - -- --- - -- <br /> SIGI�ATUR� REGISTERED Y/ N FEE CURRE� Y/N <br /> _ �-- - <br /> Address ( License# �� � <br /> , � - <br /> _ a <br /> �LECTRtG1Atd CttMPAidY <br /> SIGNATUR� REGISTERED Y/ N FEE CURRE� Y/N <br /> i <br /> Address � t�icertse# � W� <br /> i <br /> � <br /> PLUMBER CfJMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address I �icense# � �� <br /> fi�EC}iANIGAL. CC��}MRANY p f � <br /> SIGIdATURE REGISTERED Y/ FEE CURRE��� /N �� �r <br /> I <br /> Address 1 � ��� � i'��t � �icense# <br /> I <br /> I <br /> OTHEFt CtlMPAtVY <br /> SIGMATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> I <br /> Address � �icense# �_ � <br /> i <br /> 1 <br /> RESI�ENTIA� Attach{2}Plot Plans;{2}sets of Bulldfing PI ns;(1}set of Energy Forms;R-O-W PermEt fa�new construction, <br /> Minimum ten(10)working days after submi al date. Required onsite,Construction Pians,Stormwater Pians w/Siit Fence instaited, <br /> Sanitary Facilities&1 dumpster;Site Work ermit for subdivisionsllarge projects � <br /> COt41tNlERC#AL Attach(3}complete sets of Bailding Ptansp us a Life Safety Page;(1)set of Energy Forms.R-�-W Permi#far new constructton. <br /> Minimum ten(10)�working days after submi I date. Required onsite,Construction Plans,Stormwater Plans w!Siit Fence instatied, <br /> Sanitary Facilities&1 dumpster.S1te Work ermit for all new projects.All cammercial requirements must meet compliance <br /> SIGN PERMiT A#tach{2}sets of Eng[neered Plans. � <br /> ""'"PROPERI'Y SURVEY required for all N W construction. <br /> Directions: <br /> Fill out application completely. � <br /> Owner&Cont�actar sign back of apptication,notarized <br /> 1f over 52500,a Notice of Cammenaement-is�required:-E(AlG;upgrades aver=750Q} ,, , _ __ <br /> << : ���_ _ �„'� • .:�,,,.,, ,. <br /> " Agent(tor the contractor)or Pqwer;of,Attomey.(f.o[:tFie o er)'viiould be someone with notarized letker from owner;authorizing_same"";;.°�°��-Y� <br /> -. r� ' .i,t.:•�.c <br /> ONER THE COUNTER PERMITTIN6 ''(Front of Applicati ��Ortly};�'�'_° • " ' � � � _ - , <br /> Reroofs if shingles Sewers y,r',w Setvice U�igrades'A/C 'Fences(PIoUSurvey/Footage) . , _ ,_ ", '`_ � ` � _ � ' <br /> < � .,:_- :..:� . .r.<_, �.';..,._�. >��.. .._�._.. „ , ', , ���, , <br /> Driveways-Nat over Counter if on pubtic roadways..need ROW i Ms � ,�-�s�r � {4 <br /> i <br /> I <br /> � <br /> I <br /> � <br /> � <br /> - i <br />