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- - --- ---- t,ny or�ep ymms (rerm�t�►ppiication Fax-813-780-0021 <br /> u1ldEng Department <br /> � � <br />�i Dats Reaeived phone Con ct for Permittln -- <br />, ,.t�t+vner's Name �1OS� F� /�n!!O GV � � Owner Phane htumber '7�g� � �(��, <br /> T <br /> 4 (� �„��oC,�2V I�j,� ..�.� ' �� �� (y� (��� Owner Phone Number �7r8 - �r� '���rd� ' <br /> ner's Address <br /> F�e Sirnpte TI#lehalder�tame � � Chnmer Phone Number � � <br /> I <br /> Fee Sfmpte Titiehoider Addre�ss ! <br /> �B ADDRESB lf-� �` S� � !! S�;L.< 33 � ' �.oT# ��_�� <br /> ii <br /> SUBDNlSIQN C � PA CEI.ID# <br /> � i (OBTAINED FROM PROPERTY TAX NOTiCE) � _ _ <br /> ���YlIqRKPRmPtJ�ED- ` NEW CoNS7tt AD /ALT � SIC�N [� ~[,� � DEMOLISN <br /> _e`� ^1TdSTAtt RE AtR�- - , <br /> PROPOSED tISE � SFR � ,CO M , � , OTHER <br /> iYPE Of CONSTRUGTION [� BLOGK [� F ME � STEEL [� <br /> n . � /� - <br /> , DESCRIPTION OF WORK � K-2.�- �c`J !^1 f�� I. K�s <br /> BUILDIN(i SIZE � � SQ FQOTAGE � HEIGHT �,,�.�� <br /> Bt71LDING ��r-.�° ,�r(('� .. d J VALUAT dN QF TOTAL CONSTRUCTION <br /> QEIECTF2ICAL ($� � AMP SE ViCE Q PROGRESS ENERGY CJ W.R.E.C. <br /> � . <br /> [�PLt1M8tNG (s�� ���� <br /> (. i <br /> QMEGHANIGAL $ VALUAT t1N OF MECHANiCAI INSTALIATION � � <br /> QGAS {� l200FING Q SP IA�7Y � OTHER <br /> =iN4SNED FlOOR EtEVAT10TlS (��� FLO D Zt3tVE AREA [�YES 1V0 <br /> �_ <br /> l�jdILDER i � �� �OMPANY ,���'�� <br /> l� �NA"fUttE �c�sr�REO Y/ N FEE WRRE� Y!N <br /> � Address Ucense# � � <br /> j 'eCECTRtC1AN � OMPANY <br /> i �IGNA7U#tE E6tSTER6D Y l N FEE CURREt� Y/N <br /> � Address License# � � <br /> 'i.UMBER OMPANtY <br /> 1IGNA'RlRE BGfSTERED Y! N F6E CURRE� Y/N <br /> Addr�,ss L.Icelnse# � ��� <br /> AECtiANICAR. - �` OMPANY <br /> i1GNATURE �. E��s��tEQ Y t t+l FEE CURREA Y/1'+! <br /> Address I.icense# �� �� <br /> )TFiER OMPANY <br /> i1C�NATURE EGISTERED. Y/ N FEE CURREt� Y!N <br /> Address I Ucanse# � � � <br /> tE51DENTIAL Attach(2)Pbt Plans;{2�sets af Building Plans;{1)s t of Energy.FoRns;R-4-W Permft for new cons#rc�ction, <br /> Minlmum ten(10)woricing�days after submittal date.. .equlred onsite,ConsWction Plans,Stortnwater Plans w/Silt Fence l�stalled, <br /> Sanitary FadlitEes&1 dumpster,Site Work Permit fo subdivisionsllarge projects <br /> :OMMERCIA� Attach(3)complete sets af 9ufld(ng Plans plus a Ufe atety Page;(!j set of Energ}r Forms.Ft-O-W Permlt for new constructton. <br /> Minimum ten(10)worktng days after submittal date. equlred dnsfte,ConstrucUon Plans.Stormwater Plans w/SNY Fence Instatled, <br /> Sanfitary Factlities&1 dumpster.8tte Work Permit fo all new prl jects.Ati commercial requirements must meet compliance <br /> - s!G(d PERMl4 Rttach(2j�ets of Enginesred Plans: <br /> "'"PRQP6RTY SURVEY required far all NEW cans ctlon. <br /> , <br /> �Irectlons: � <br /> Fill out appUcatlon completely, I <br /> Ovmer&Contractar sfgn back of apptica#ton,notarized <br /> ff over 52�40,a�lotice of Gommencement is caaquired. {AtG up racles ovgr ST540} <br /> ' Agent{tor the+r,ontractor)or Power of Attomey{!or the owner}woald be someot�e wlth notarized tetter ftorst ov+mer authorfxtng same <br /> �VER THE COUN7ER PERMlITTING (Front of Applfca�on Q�fy} <br /> ;eroofs if sh(ngles Sewers Service Upgrades A/C Fenc (Piot/8u'�ey/Footage� <br /> i <br /> Driveways-Not over Caanter if oti public roadways..needs ROW ! <br /> 1 <br /> � <br />