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o„-,o�,�v Gity ot Lephyrhills Permit Appiication �aX a�a-�saoo2�
<br /> 8uilding Department
<br /> #e R�ceived ,r�' � phone Contact for Permittfn —
<br /> /�/� `'�-�`�1 � Owner Phona Number '�l��
<br /> rner's Name t ' 1 � �_�.�
<br /> rner's Address ��"1� �� ��' Owne�Phone Numbgr _L�"t(i" �� I 't�� l
<br /> e Simpie Tittehoider Name � dwner Phane Namber `
<br /> a Simpte Titleholder Address
<br /> B ADQRESS l.OT# �
<br /> 'BD(VISION ��� p�CEL ID#
<br /> (OBTAINED FROM PROPERTY TAX NOTICE)
<br /> ?RK PRQPQSED e NEW CONSTR 8 _ ADbiAIT � SiGi3 Q Q DEMOi�iSH
<br /> ENSTALI. REPAiR
<br /> ,OPOSED USE Q SFR Q COMM [� OTHER
<br /> PE OF CdNSTRUCTiON K Q FRAME C '
<br /> SCRIPTION OF WORK '. f`�� � �✓����� � �r�ln _ d d � �
<br /> �ILDIN�Si2E - 6"�2�� y' �� SQ FOOTAGE HEIGNT
<br /> QBUILDlNG � A J` Q` VA�UATION OF TOTAL CONSTRUCTION
<br /> 11W
<br /> [�ELEC7RICA� ($ —� �� AMP SERViGE Q PROGRESS ENERGY Q W.R.E.C.
<br /> ���
<br /> [�PLUMBING $ ��p��'�
<br /> �
<br /> MECHANICAL $ VAI.UATION OF MECHANICAL WSTAI.LATION � �� ����
<br /> � ����,��J
<br /> OGAS Q ROOFIFIG Q SPECIAL,TY � OTHER
<br /> 14SHED FLOOR EIEVATIONS �� FIOOD ZONE AREA QYES Fid
<br /> ILDEFt � �(Y7�?��3-)�.0� � � COMPANY , . fi
<br /> iNATURE REGISTERED Y/ N FEE CURRER NI
<br /> Address License# � " �
<br /> ECTRICIAN � � COMPANIf
<br /> �NATURE t�ecis�R�o Y i N FBE CURRE� Y/N
<br /> Address Llcense# ri y�`�
<br /> 1MBER � � COMPANY
<br /> �NATURE REGISTERED Y! N FEE GURREt+ Y I 1V
<br /> Address License# �' ��
<br /> CHANfCA! COMPNNY
<br /> NATURE _, REGISTERED Y/ N PEE CURREt+ Y i N
<br /> Address License# � ��
<br /> tER �� COMPANY �
<br /> NATURE REGI3TERED Y/ N FEE CURRE� Y/N
<br /> Address _ _ - - �fcense#� �` `� � � �
<br /> ►10ENTlAL Attach(2)Plot Plans;(2)sets of 8n3lding Plans;(i}set of Energy Forms;R-O-W Permit far new canstrucBon,
<br /> Minimum ten(10)working days aRer submittai date. Ftequirect onsite,Construction Plans,Stormwater Pians w/Silt Fence tnstalled,
<br /> Sanitary Facilftles&1 dumpsier;Sfte Work Permit for subdivisions/large projects
<br /> AMERCIAL Attach(3)complete sets of Buitdfng Pians ptus a Life Safety Page;(1)set of Energy Forms.R-Q-W Permit fa�new construc8on.
<br /> Min]mum ten(1Q)working days after submittal date. Required onsite,Canstruction Ptans,Stormwate�Plans w/Silt Fence lnstalled,
<br /> Sanitary Facflities&1 dumpstar.:Site Work pertnit for all new projeats.All c�mmercial requlrements must meet compliance �
<br /> N PERMIT Attach(2)sets of Engineered Pians. '"�' -
<br /> ""'PRQPERTI'SURVEY required for at�NEW constructlon.
<br /> ctlons:
<br /> Ffll out appltcation compietely.
<br /> Ov+mer&Contractor slgn beck of apptication,notarized
<br /> tf over 52500,a Natice of Cammencement ls required. (A/C upgrades ovar 57500a ..,,:,z,...��-<.•4�-••.• _ >._- ^�- - °"'��
<br /> a' ,� ';. i
<br /> /�qent(for the contractor)or Power of Aktomey(for the owner)would b.e;sa�eone wikh notarized letter from bwner autho�iztng�same;.:=�.;` v =_, �� �
<br /> ER THE COUHTER PERMITTiNG<..= -(Frii f'of PPi+�.:..�„ • ��•�.�' t. � t"'�: :_ , �, ;i, . _ '''_` .
<br /> n .A ication'C3nly),-: •i;'; ; :;' :,;,,�.
<br /> rofs If sfiingies Sewers 'Service.Upgrades. f11C•. Y.Ferices�(p,l`ot�Survey/Footage) 's: _ ,.,. .. , „- . '° .. • `,.,r., •
<br /> '; 1� :::. ,r� �. ;,..;�j .:;.i::',:_::,:�� 4 G..,. .. .. � .�,.....�..,,,,� ..�,.�... _ , .
<br /> c". � . . . �
<br /> Driveways-Nat aver Gounter if on�public,roadways:.needs ROVV �'';;;��;�.,�.,,:
<br /> � " wg..+�`�YCtt!
<br /> -�.vstt'b'.Mrc'l w.r-a�vi
<br /> 'y',-..:`. r t '
<br />
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