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sl$aeo-wzo City of Lephyrhills Permit Application rax-esls-rau-uuri
<br /> 1 Building Department
<br /> DateRecelyed. Phone•COntac 1or-Perrnitting �CD — ✓7 70a)
<br /> Owner's Name Owner Phone Number
<br /> Owner's Andress. Owner Phone Number
<br /> Fee Simpl®Titleholder Name^:. 7i � Owner°Phone Number-
<br /> Fee Simple Titleholder Address
<br /> JOB ADDRESS � co LOT#
<br /> SUBDIVISION PARCEL ID#
<br /> 1 (OBTAINED FROM PROPERTYTAXNOTICE)
<br /> WORK°Pt,OPOSED NEW CONSTR' AD.D/ALT 0 SIGN' C] Q DEMOLISH
<br /> e INSTALL. 8.. -:REPAIR
<br /> PROPOSED;USE•• 0 SFR -COMM: = OTHER `
<br /> TYPE"OFCONSTRUCTION .Q 'BLOCK Q -FRAME Q. STEEL Q.
<br /> DESCRIPTION OF•WORK
<br /> -BUILDI SQ`FOOTAfaE • .•HEjGHT : � _ -
<br /> :;
<br /> =BUILDING $ VALUATION'OF TOTAL CONSTRUCTION",-
<br /> =ELECTRICAL $ AMP SERVICE _ -PROGRESS ENERGY 0 W.R.E.C.
<br /> =PLUMBING $
<br /> i
<br /> MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
<br /> =GAS Q. ROOFING Q SPECIALTY. = OTHER.
<br /> FINISHEDIFLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
<br /> 17
<br /> .:BUILDER . COMPANY
<br /> SIGNATURE REGISTERED Y/ W,'•. FEE:CURREP
<br /> Addr®ss License,#'
<br /> ELECTttICIAPI_. :a : COMPANY
<br /> :'SIGNit►TURE REGISTERED Y/ N FEE CIiRREP:.-` Y/N.
<br /> Address :License#.
<br /> PLUMBER,.::. 'COW PANY:::
<br /> SIGNATURE" REGISTERED Y/'"N-:' FEE CURREh,r-
<br /> :n.
<br /> Address C Licen'se# ;z
<br /> AAECHAPII'CAL :.COMPANY :L 1�
<br /> ` SIGNATURE'•`• ' °' REGISTERED Y/:N' FEE;CURREh .Y:/N .:
<br /> Addres;L'1:' License.# . 17
<br /> COMPANY'_.:
<br /> `REGISTERED' FEE CURREK Y/N
<br /> • Address�..,..;..r_.:.,=h,F.,;�,;-, ;f; r,..• `Lioerise
<br /> -
<br /> >,:_;� •z''" `�-RIa s .1 >seto,Ene Forrris��RO=ViF:Pe�rnitfornew;' n. tru ...`'_
<br /> ;.1•..RE$IDENTIALS.. AtNac1�,(2)PlotPlans'j2)sets`ot<�Buil�inga, n ,O rgY, ,„ a cA_ tl„ _
<br /> M'.. .:•: : •:_ s' i n` 10.sins&"'n''"`.da F'':after;°�iiia ital a te Re'aired onsiteY Construction Plans,StoirtLwater`Plansw/°Silt'Fencef mWIled;
<br /> 4 Min)nuI—t®. . q
<br /> Sanity F.aciliti®s2&Jum ste i`IQTWorlc:Perrrrlt for�subd v1siogs/iarg®'ProjQcts:.-. ;` `t:"r-
<br /> r.:.�Ut', ki3F.Y;4.i. _ t1 5.,...X_
<br /> .;.• t.. y, :_,, r•.<i—.>., ,......::
<br /> "F COMMERCIAL Atta M."cotTiplete's'®ts of B"i di ing"Pians pius'a Life'Safety Page;(i)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-FaGI(ties.&1 dumpster.Site Work:L?ermiYfo all-newprojects.All commercial requirements must meet compliance
<br /> `:SIGFI?PERf1AIT Atfa'chiOsetsQf#Ei�gin®erectPlans?i{:tG:'J'a`:;1''.A-:'i'•
<br /> a x
<br /> •. ^-'r ***!PROPERTY.SURVEY reguired.f4r„a II,NE.W;constructlon...._•
<br /> { Diectio'ris: S,rs; c _ ;FI•,.-a
<br /> " Fill;out Ca co
<br /> "O,uvner.&,Contractor'sign°back&,application,notarised
<br /> `?If;over42500;a Notiti.,6cCommencement is required. (AIC upgrades over$7500)
<br /> 0
<br /> N>
<br /> �.�•,•-<:_. gent'fortheconfn3ctoe?:rRower'of'Attome'`for.the owner.would'tie"someone with notarized.letter,ro y( )" m owner authorizing same
<br /> ^'.COVER'i,THE�COUNYER;�PE,RAAITTING';:.,..:•:.;..(.copy�of contract�regWlred)- ""''�" ""
<br /> . 'r:Reroofsifafiingles S®avers. :Service Upgrades,A/C,: Fences(Plot/Survey/Footage)
<br /> =Drty®ways-Not over.Counter i,on�public'�roadways rieeds'ROVI/� • ' .
<br />
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