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�,s-�nu-uuzu C:ity ot Lephyrhills Permit Application Fax-813-780-0021 <br /> Building Department , <br /> Date Fte,ceived,s` Phone Contact for Permitt(n -- <br /> Ourner's fdame �� � �DLt' O�. Owner Phone Mumber -'�� � � <br /> Owner's dlddress �`�70 ��� �� �/ �Z O�uuner Phone Rlumber <br /> Fee Simple Titleholder ldame Obmer Phone Rlumber <br /> Fee Simple Titleholder Address � <br /> JOB rADDRESS tiJ l�C/� 2T/{ � ' 7/�Zy� � `j'��lo`Z LOT# � <br /> SUBDINISIOfd PARCEL ID# ����a�„2���°'tXSI�00°f,f� �� <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> HNOREC PROPOSED B NEW CONSTR� ADD/ALT Q SIGN [] Q DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SFR Q COMM Q OTHER <br /> NPE OF CORlSTRUCTIORI Q BLOCK Q FRAME Q STEEL Q <br /> pESCEtIPTIOId OF WORK 2� Sr I ; <br /> �UILDIfdG SIZE SQ FOOTAGE HEIGHT <br /> QBUILDING $ VALUATION OF TOTAL CONSTRUCTION <br /> �,'�LECTRICAL $ ��.o AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C. <br /> QPLUMBING $ <br /> �MECHANICAL $ VALUATION OF MECHANICAL INSTALLATIOfV �V � �� � <br /> D� - <br /> i QGAS Q ROOFING Q SPECIALTY � OTHER <br /> FIfVISHED FLOOR ELEVATIONS FLOOD ZONE AREA [�YES NO <br /> BUILDER COAAPAMY <br /> �IGIdE1TURE REGISTERED Y/ N FEE CURRE� Y/M <br /> Address License# <br /> IEL.ECTRICIAM COMPAfdY /' /ci/ r. ^�/ rl G <br /> SIGtdE1TURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Alddress 3 � �3,�,5 License# �� �� <br /> PLIDAABER COAAPAfdY <br /> SIGfd�4TURE REGISTERED Y/ N FEE CURRE� Y/N <br /> 4►ddress Ucense# <br /> Af1lECHA1dICAL ���%�us COMPANY ,tiI��S I „�'�Gt��'f � .c,�S <br /> �IGMATURE �y `�`- REGISTERED N FEE CURRE� N <br /> Address /D(o�/ S�•G�S.�D �✓,1,���'�' ��SL l.icense# �� � �fi� <br /> OTHER COMPANY <br /> SlGfde4TURE REGISTERED Y/ N FEE CURRE� Y/N <br /> d►ddress License# <br /> RESIDEMTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-VN Permit for new construction, <br /> Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilitles 81 dumpster,Site Work Permit for subdivisionsAarge projects <br /> COMMERCIAL Attach(3)complete sets of Buflding Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction. <br /> Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities 8�1 dumpster.Site Work Permit for all new proJects.All commerciai requirements must meet compliance <br /> SIGfd PERMIT Attach(2)sets of Engineered Plans. � _ - - <br /> •'"•PROPERTY SURVEY required for all NEW construction. <br /> Directions: <br /> Fill out applicatfon completely. <br /> Owner 8 Contractor stgn back of application,nota�ized <br /> If over 52500,a Idotice of Commencement is required. (AIC upgrades over�7500) <br /> '• Agent(for the contractor)or Power of Attomey(for the ovmer)would be someone with notarized letter from owner authorizing same <br /> O!/ER THE COUfdTER PERMITTI(dG (Front of Applica�on Only) <br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage) <br /> Drivevxays-Not over Caunter if on public roadways..needs ROW <br />