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813-780-0020 City of�ephyrhills Permit Application Fax-813-780-0021
<br /> • Building Department .;W
<br /> Date Received "
<br /> Phone Contact for Permitting � --
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<br /> Owner's fdame L Owner Phone Number p�1 -(Q '
<br /> Owner's Address �� � i Owner Phone Number
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<br /> Fee Simple;Titleholder Name Owner Phone Number
<br /> $ - ,
<br /> Fee Simple;Titleholder Address
<br /> � �JOB ADDRESS � LOT#
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<br /> SUBDIVISION � PARCEL ID# � � �U��(�v�8--��D �
<br /> i (OBTAINED FROM PROPERTY TAX NOTICE) �
<br /> WORK PROPOSED e . NEW CONSTR 8 ADD/ALT � SIGN Q Q DEMOLISH
<br /> i INSTALL REPAIR
<br /> PROP,OSED USE � SFR Q COMM � OTHER .
<br /> TYPE':OF CONSTRUCTION BLOCK • Q FRi4ME � STEEL Q
<br /> DESCRIPTION OF WORK � D w�.. b ��
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<br /> BUILDIPIG SIZE SQ FOOTAGE .LCQ� � HEIGHT •
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<br /> ��B,UILDING $ �� VALUATION'OF TOTAL CONSTRl1CTION
<br /> `�"``? ' O� —
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<br /> QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
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<br /> OPLUMBING $
<br /> f � C��� f����a�vx�
<br /> QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
<br /> ► � ��-s
<br /> QGAS Q ROOFING Q SPECIALTY Q OTHER
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<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO �/Lv` �
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<br /> BUILDER ' � [
<br /> SIGNATURE R O�E�� Y�/ N F�rtR� Y/N. .
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<br /> Address License# -
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<br /> ,-:'ELECTRI,C,IAN ;, COMPANY
<br /> :- SIGNi4TURE REGISTERED Y/ N FEE`CURRE� Y/N
<br /> - Address License# �
<br /> PL6JMBE,R.�., COMPANY .
<br /> SIGPIAT.URE REGISTERED Y./ N . FEE CURRE� Y/N
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<br /> Address � License#
<br /> ' MECHANICAL' COMPANY
<br /> ' SIGNATURE" � REGISTERED , Y/ N , , .FeE cuw�en Y•/N -
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<br /> Add�e§s :., ` � • ' ' � License.#, .� �
<br /> -<c�:, � .
<br /> :_ OTHERN' ``�:•� � ` COMPAfdY
<br /> �=SIGNATURE3� :_ _ - REGI3TERED Y/.N FEE CURREK Y/N - I
<br /> I �r::`, ;1: �. . . . _ .. . "
<br /> Address�: - - - � - - � License# �
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<br /> �;RESIDENTIi41.,-:`'�Attacti�(2)",sPlot�Rians;''(2)`'sefsof�Building'Plans;(1)`set ofEne�gy:Fomis;R=,O=W Permit:for new.construction�=
<br /> � Minimum=ten_(10)iworking;days';afte��'s.u6mittal:dafe. Required'onsite;Construction'-Plans,`Storinu"vater Plan"s�w/Silt Fence installed,
<br /> , •-.::.:{;;�,,,;�;" ,- �. .,....,�.
<br /> _�,. � � `Sanitary:{Facllities�&;1s,du,mpste�;Site:±WorkFermitfor..subdivisions/large:projecfs: - ' ' � - ' '
<br /> �=�`,COMMERCIAL Attach�(2)'complete''s'ets of'Building.Plans plus a Life Safety Page;(1)set of Energy Fortns.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 Facitlties 8�1 dumpster.Site Work Permit f6�%all,new-p�ojects.All commercial requirements.must meet compliance
<br /> �..SI'GN�:PERMIT -AttaoFi(2)sets:of;Engineered�Rlans:`�= � : , � � ,
<br /> ti;>,; ""*PROPERTY SURVEY,required for aILNEW construction:- .
<br /> ���; - - - �-- . � _ . _ d
<br /> �;Directions: r::�;;�,,-:-� � - .
<br /> _ �Fill-out�application completely. ,
<br /> Owner`&Contraotor sign back of applicaUon,notarized
<br /> ;�; If over$2500,a Notice.of Commencement is required. (A/C upgrades over$7500)
<br /> "" AgenY(for'4fi'e`aont�actor)�or�Power of'Attomey'(for tlie owner)would be someone with notarized letter from owner authorizing same
<br /> `'�OVER:THE'COUNTER�PERMI7TING, ,.(copy_of�contract.required) � -
<br /> t��Reroofs if'sfiingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage)
<br /> Driveways-Not over Counter if on public roaiiways..needs ROW
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