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<br /> 813-780-0020 City of Lephyrhills Permit Application Fax-813-780-0021
<br /> Building Department
<br /> Date Received � I � Phone Contact for Permitting —
<br /> Owner's Name �J� (�� o{.l��l,(�- ��r � Owner Phone Number ��' `l7� - sa sb
<br /> Owner'sAddress �38�5 C. ��da c.00 �T(��1.5 �� I� OwnerPhoneNumber
<br /> Fee Simple Titleholder Name Owner Phone Number
<br /> Fee Simple Titleholder Address
<br /> JOB ADDRESS ,J OU� (.,a���l�t. �W � l ell�f S �� ��`� /� LOT# �
<br /> SUBDIVISION PARCEL ID# —� ��( � V I lo�� U�� � v��U
<br /> (OBTAINED FROM PROPERTY TAX NOTCE)
<br /> WORK PRQPOSED B NEW CONSTR e ADD/ALT 0 SIGN 0 � DEMOLISH
<br /> INSTALL REPAIR �� �n
<br /> PROPOSED USE � SFR Q COMM 0 OTHER
<br />, TYPE OF CONSTRUCTION � BLOCK Q FRAME 0 STEEL 0
<br /> DESCRIPTION OF WORK '���Cri'� �e"�UUT � l cxtres h l(� -GS
<br /> BUILDING SIZE SQ FOOTAGE I OV HEIGHT
<br /> QBUILDING $ (��'}7� O'1'� VALUATION OF TOTAL CONSTRUCTION
<br /> —! Ga V
<br /> �ELECTRICAL $ AMP SERVICE � PROGRESS ENERGY 0 W.R.E.C.
<br /> �� f�
<br /> �PLUMBING $ �
<br /> OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
<br /> �GAS � ROOFING Q SPECIALTY � OTHER � ��
<br /> f
<br /> 2
<br /> FINISHED FLOOR ELEVATIONS
<br /> FLOOD ZONE AREA YES NO
<br /> 0
<br /> BUILDER COMPANY
<br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address License#
<br /> ELECTRICIAM COMPANY
<br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address License#
<br /> PLUMBER COMPANY
<br /> SIGNATURE REGISTERED Y/ N FEE CURREt� Y/N
<br /> Address License#
<br /> MECHANICAL COMPANY
<br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address License#
<br /> /y� �nc•
<br /> OTHER n, � ra �,`!`� COMPANY �el� �n
<br /> SIGNATURE '�A K�fJV REGISTERED / N FEE CURh n Y/N
<br /> Address �ll���� f S� J ' l 33S License# l' � ✓��5� )
<br /> 1 1 1 1 1 1 L 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ! 1 1 1 1 1 1 1 1 1 1 ! 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
<br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(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 Pla�s w/Silt Fence installed,
<br /> Sanitary Facilities&1 dumpster;Site Work Permit for subdivisions/large projects
<br /> COMMERCIAL Attach(3)complete sets of Building 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&1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance
<br /> SIGId PERMIT Attach(2)sets of Engineered Plans. -
<br /> ""PROPERTY SURVEY required for all NEW construction.
<br /> . . . . e . . . . . . . . . . . . . �.
<br /> Directions:
<br /> Fill out application completely
<br /> Owner&Contractor sign back of application,notarized
<br /> if over$2500,a Notice of Commencement is required. (A/C upgrades over$7500)
<br /> " Agent(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
<br /> OVER THE COUNTER PERMITTING (Front of Application Only)
<br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage) _
<br /> Driveways'NoYover Counterif'on public roadwa,ys�.needs ROW �� �- ,• � � • �'+', ' ' �,�
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