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s13-73U-0U2U City of Lephyrhills Permit Application rax-ola-rov-V„41
<br /> Building Department
<br /> Date Recelrred Plibno-Contact'.for"Permitting`�1,-
<br /> LAA"A
<br /> : C r
<br /> Owner's Name Owner Phone Number
<br /> OWnees Address. ' .O 3" 4 S LL 1 f kI\� �' Ow►b®r Phone Number
<br /> Fee Simple Titleholder Name owner'Ptione Number"
<br /> Fee Simple Titleholder Address
<br /> JOB ADDRESS S ( D l�h S� ZtG r Vl( l S LOT#
<br /> SUBQIVISIOM PARCEL-ID#:
<br /> r
<br /> � (OBTAINED,FROM PROPERTY TAX NOTICE) '
<br /> WORK PROPOSED ... NEW CONSTKE]. ADD)ALT 0 SIGN' Q 0 DEMOLISH
<br /> INSTALL REPAIR
<br /> A.
<br /> PROPOSED;USE• Q SFR = "Comm Q OTHER
<br /> TYPE'•OF CONSTRUCTION" 0 'BLOCK = 'FRAME: Q. STEEL:
<br /> DESCRIPTION OF WORK F 1Ma V C' (7 C�� Y d S � +
<br /> BUILDIWGSSIZE S4 FOOT/►GE "2J, HEIGHT:• ::.. S EOM
<br /> [BUILDING $ Zb O VALUATION'OF TOTAL CONSTRUCTION
<br /> =ELECTRICAL $ AMP SERVICE = PROGRESS ENERGY 0 -W.R.E.C.
<br /> =,PLUMBING $
<br /> =MECHANICAL $ VALUATION OF MECHANICAL.INSTALLATION.
<br /> =GAS Q. ROOFING- Q SPECIALTY. 0 OTHER.
<br /> FINISHEDiFLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
<br /> :BUILDER] OMPANY
<br /> SIGNATURE REGISTERED Y-/ NCB, 'FEEZURREN
<br /> Addr®ss License:#' e C G 3 Z-7 �O
<br /> `.ELECTRICIML ;. COMPANY
<br /> 'SIGNATURE REGISTERED Y/ N FEE CURREf•':. Y/N-
<br /> Address License#.
<br /> PLUI�BIR,; COMPANY';:
<br /> SIGNATURE" REGISTERED Y/ N,: FEE GURREfi: Y/.:N
<br /> Address. ; Licen'se.#
<br /> I .
<br /> '.'.MECHANICAL" ;.COOMPANY. _. ... I .
<br /> ;.:
<br /> "REGISTERED FEURRESIGNATURE.-L! , Y/N .=: :- .•.
<br /> AildPe s} License.#
<br /> COMPANY •.
<br /> SIGNATURE; tf r ,- REGISTERED Y/N FEE CURREK
<br /> °License'#
<br /> -
<br /> E AID N it ,'cP' I" "F,B�ljl Plans ,1 elofEn' -Forms R0=1NPe" 'lt "raew.constuc_tion
<br /> R S E,.TAL�;�'>, :Att�cli,�(2),,Iot;P.,ans�•:(2)setsof, ul ng.r n ,( )�s er9y. ,�.• rtn f° ;�,>,, ,_
<br /> ,: :.•a=: , ;:Mini um' 10.wvorkiii"'da"`aftefi. ubin ttei date sRe wired'onsite Construction Plans"Stolr�lwater Plans w/Sflt Fence'installed;
<br /> v±Sanitar:°Facilities;&r,1rdum ste, i Worlc<Permit.fo�sutidivlsidp§/fa. e° ro sets'.:,::
<br /> .< :rye. .-,�,,.: ; p. ;:. 4 ; ..,.,... .:-,:_.�s,.p, l....
<br /> COMMERCIAL Attach7j2)complete"sets oft0liding-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,Stomtwater Plans w/Silt Fence.installed,.
<br /> Sanitary Facilities&_1 dumpster.Site Work Permit:fo�all=new projects.All commercial requirements.mustmsat compliance '
<br /> PERMIT Attach( sets;o iEngin eted�Plaris;
<br /> ""PROPERTY SURVEY required,i'or,aII,NEW construction:-..
<br /> -��-'Dire'gtloris:: :c•,,s c,>,-w3:. .. -.. _.
<br /> =:�'<;��= �:Ftlh'out�application.completely. •
<br /> :Owner`&Contractor.`sign:back ofapplication,notarised
<br /> >..
<br /> e: 'If"over'$2500;.a-Notice;of:Commencement Is required. (A/C upgrades over$7500)
<br /> "t" :/gent(fdr�the contractor)<.or PoWer:of Attori�(ey(for'the owine�)`wouid-66 someone with notadzed.letterfrom owner authorizing same
<br /> Q11ER;THE'COUNTE_R-PEI�EIALITIN_ Gw:-;r•_,..(coPYofbcontrachrequked)�
<br /> Reroofs.ifaliirtgles `Sewers :Service Upgrades NC Fences(Plot/Survey/Footage)
<br /> _ . :D�tireways-Not over Counter if on-publid roadways:neeiis"ROIN� - ,
<br />
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