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� <br /> o�a-rov-wc� uiry or cepn m�ns Permit Appiication Fax-813-780-0021 <br /> t B Rding bepartment <br /> Dafe Received � _ <br /> Phone Conta t for Permitting <br /> Owriar's Name Owner Phone Number V�� r� � <br /> -� <br /> Dwner's Address I �',.. � � C?wner Phone Number p 1.�-�7� 1- 1�7� <br /> Fee Simpie 71Neholder Name Oumer Phone Number r� � <br /> Fee Slmple 7ttleholder Address <br /> «.,_ <br /> JOB ADDI2ESS. � � I �� L07# L�1 <br /> � <br /> SUBDNlSlOM �� � PA CEL Ip# � <br /> _._ _ _ —_ �-_ _._ - __ .� - --- - -- _ I�_______(OBTAfNEQ_ERqM.P_ROP_ERTY�AX NC?TlCE)-=----—�`-_ - -_— � <br /> WORK PROPOSED � � NEW CONSTR 8 AD A�T [� SIGN 0 Q DEMQL4SH <br /> INSTAI.L RE IR ' <br /> I <br /> PROPOSED USE Q SFR [� CO M � OTH�R <br /> IYPE OF CONSTRUCTION [� BLOCK L] F E ,� : BTEEL Q <br /> , i <br /> DESCRtPT10F1 OF WORK � <br /> BUILDING SlZE � � �� SQ FOOTAGE FlEIGHT �� <br /> ,_,� <br /> QBUILDING $ G�� ,ry� t5'L�� yq��AT N OF T4TAt�GONSTRUCTlON <br /> flt t)lJ <br /> QELECTRICAL ��� AMP SE VICE Q PROGRESS ENERGY � W.R.E.G. <br /> QPLUMBING ($�--^-� �� <br /> �w �� <br /> QMECHANiCAL $ VALUAT ON OF MECHANICAL INSTALLATION � �� <br /> �GAS �] ROOFING Q SP CIALTY I�„�� OTHER <br /> =1NISHED FLOOR ELEVATIONS (� � FLO D ZONE AREA QYES NO <br /> (� <br /> �UII.DER r f� � COMPAMf <br /> 3�fi�!'+OIA3UP.E �CQ.�,,,,�-'„ti�i'� , REGISTERED Y/ N FEE CURRE� Y/N <br /> add��ss �E��S�# �— _._ ..�.� <br /> :LEGTRiC1AN � COMPANY <br /> 31CiNATURE REGISTERHp Y/ N FEE CURRE� Y/N <br /> Address Lfcense# �— `� <br /> �1.UMBER �� COIlAPANY <br /> 31GNA�URE ,,," EGISTERE� Y J N FEE CURRE� Y/N <br /> Address Ucense# �� �� <br /> AEGFIANICA� � COMPAN'Y <br /> ilGNATURE EGtsTERED Y! Td FEE CURRER Y/N <br /> Address License# � � <br /> )7FiER CQMPANY <br /> {IGNATURE EGISTERED Y I �1 FEf CURREh Y J N <br /> Address License# � �� <br /> tESiRENTtAL Attach{2)Ptot Ptans;{2)sets of Buliding Pians;(1) et of Ene� Forms;R-O-W Permit for new cons#rucfton, <br /> Minimum ten(10�worktng days after submittal.date. Requlred�onsite,ConsWc@on Pians,Siarrnwa#et Pians wt Slit Fence instalted, <br /> Sanitary FaclNtles&1 dumpster,Site Work Permit f r subdivistonsAarge projects <br /> :4MMEttC1AL Attach(3}comptete sets of Suitdtng Ptans ptus.a Lif Safeiy Page;(1j set of Energy Forms.R-O-W Permlt for new canstruction. <br /> Mtnimum ten(10)warktng days after submitta!date. Required�onsite,Constructlon Plans,Starmwater Plans w!Sfit Fence instaiied, <br /> Sanitary Facilitles 81 dumpster.Site Work Permit f r all new proJects.All commerclal requiremants must meet compllance <br /> �IGN PERMI7 Attach(2j sefs of Engineered Ptans. � <br /> ""'"PROPERTY SURVEY required for all NEW con cttan. ( <br /> i }irections: <br /> F411 out applicaUon oompietely. <br /> Owner&Contractor sign back of applicatlan,notarfzed . <br /> tf over�2500,a Notice af Cornmencement Is requtted. (A/C u grades over�7500) � . , r <br /> ' ' Agent(for the coMractor)or Power of Attomey(for the awner)wou d be sameone with notarized tetter fram awne�authorizing same� ' � ` <br /> � ��,. <br /> NER THE COUI�TER PERM117tNG (Front of Applica�on On1y} �"" w..r ,X•^. �t•:° --�"'"•`•' " `; <br /> ;eroofs it shingfes Sewers Servlce Upgrades AfC Pen s(PiotlSuroeylFootage) ;'v - . `''•�".''',,r: �-3 ''`^ -t„�"" '; <br /> $ G ;�: : " �,: `'�'�'���.' . ; �." c. <br /> Driveways-Not over Caunter lf on pubtic roadways..needs ROW „ ���� �. '�"' '"'� `�" °`�::'� ; <br /> ,F ..—. ——.c ._.rr'i.,:.r:. ,_.�",t:.._.....—_ .._w.. <br /> � <br />