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utty of Gephyrhills Permit Application Fax-813-780-0021 <br /> Building Department <br /> rPhone <br /> SIkQUCktcttRC a rv, C ) <br /> Date Received <br /> Phone Contact for Permitting <br /> Owner's Name Owner Phone Number �o <br /> Owner's Address .�,.— '�M -D��ovntfi 3S ��"Owner Phone Number <br /> Fee Simple Titleholder Name F Owner Phone Number <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS S�TyV r f 1 S L- 33 LOT# �p <br /> SUBDIVISION - ARCEL ID# �Z '6 d 60100 C C <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED (_`_1 NEW CONSTR 8 AbD/ALT SIGN DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE 0 SFR COMM OTHER <br /> TYPE OF CONSTRUCTION BLOCK FRAME STEEL <br /> DESCRIPTION OF WORK SeA S <br /> BUILDING SIZE SQ FOOTAGE t �y �f HEIGHT <br /> =BUILDING r$ t a*) I VALUATION OF TOTAL CONSTRUCTION <br /> =ELECTRICAL $ �Of AMP SERVICE 0 PROGRESS ENERGY W.R.E.C. <br /> =PLUMBING it 6o <br /> =MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION <br /> =GAS ROOFING SPECIALTY OTHER <br /> FINISHED FLOOR ELEVATIONS + =� FLOOD ZONE AREA =YES NO <br /> F 2,:S-' C 1BUILDER /t � /` COMPANY C <br /> SIGNATURE 1•� REGISTERED •Y/ N FEE CURREN Y I N �} <br /> Address License# 2 I <br /> LECTRICIAN COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURREA <br /> Address (}6 i� 3 License# cl- o 6 Sa ! <br /> SLUMBER if COMPANY 1` 5 Ui fi <br /> SIGNATURE F REGISTERED Y/ N FEE URREN u/N ! ^� <br /> Address �:3�a b c �Gl S t /om License# CF�� !Z /.3 7` <br /> VIECHANICAL COMPANY 5� <br /> ±C S <br /> 31GNATURE V/'N FEE CURREA Y/N <br /> Address License# FCA C(-,33`` w <br /> )THER _____- COMPANY r N ca Cat yns <br /> 'SIGNATURE REGISTERED Y/ N FEE CURREA Y/N <br /> Address License# I cc <br /> llllil11-iI111II1IIIIIIIIIIIII ` 11IIlil .1 till till lIIl1IIIIIIIIIIIIIIIII <br /> 2ESIDENTIAL 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 Plans w/Silt Fence installed, <br /> Sanitary Facilities&1 dumpster,Site Work Permit for subdivisions/large projects <br /> ,OMMERCIAL Attach(2)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-d-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 /> ;IGN PERMIT Attach(2)sets of Engineered Plans. <br /> ""PROPERTY SURVEY required for all NEW construction. <br /> Ilrections, <br /> Fill out application completely. <br /> Owner&Contractor sign back of application,notarized <br /> If over$2500,a Notice of Commencement is required, (AIC upgrades over$7500) <br /> ` Agent(for the contractor)or Power of Attorney(for the owner)would be someone with notarized letter from owner authorizing same <br /> )VER THE COUNTER PERMITTING (copy of contract required) <br /> :eroofs if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage) <br /> Driveways-Not over Counter if on public roadways,.needs ROW <br />