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silty Ot'Gephyrhills Permit Application Fax-813-780-0021 <br /> Building Department <br /> Date Received ��u" rWo'*'`c`�M <br /> Phone Contact for Permitting <br /> Owher's Name Owner Phone Number - � (A <br /> Owner's Address J� Owner.Phone Number <br /> Fee-Simple Titleholder Name Owner Phone Number <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS O LOT# <br /> SUBDIVISION - Q V `- ;�ARCEL ID# Z� ^��' Z t3' 6D ZM__- <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED. NEW CONSTR F7 ADD/ALT u SIGN = = DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SPR 0 Comm OTHER <br /> TYPE OF CONSTRUCTION BLOCK FRAME STEEL <br /> DESCRIPTION OF WORK W 1 eAffi <br /> `S <br /> BUILDING SIZE SQ FOOTAGE $ HEIGHT F____� <br /> =BUILDING $ q Qt_ VALUATION OF TOTAL CONSTRUCTION <br /> =ELECTRICAL $ AMP SERVICE = PROGRESS ENERGY W.R.E.C, <br /> =PLUMBING $ <br /> Q(3=MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION <br /> GAS ROOFING 0 SPECIALTY OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA OYES NO <br /> BUILDER /� COMPANY Inc. <br /> 5I.GNATURE V' REGISTERED Y 1 N FEE CU(RRREN� Y 1 N <br /> Address License# <br /> ELECTRICIAN � COMPANY <br /> SIGNATURE REGISTERED I Y/ N FEE CUR/R—EP I Y/N . <br /> Address (}(� 3 License <br /> SLUMBER COMPANY 5U M Ji+1 <br /> SIGNATURE REGISTERED Y I N FEE URREN L N <br /> Address 3�� b C�}Eh W SJ-f 10M 46 6 License# cF n 1 Z - 13 T . <br /> MECHANICAL COMPANY <br /> 31GNATLlRE REGISTERED VVN l FEE CURREN Y/N <br /> Address J`�o�. License# C-U 33 W <br /> )THER COMPANY <br /> iIGNATURE REGISTERED Y/ N FEE CURREN Y/N <br /> -.Address License# cc II <br /> III:IIIIIIIIIIi,illlillllllilll' IIIIlIIIIIIlIIIIIIIIIIIIIiIIIiII.-I1111 <br /> ZESIDENTIAL 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 Pians.wi 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-O-W Permit for new construction. . <br /> Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans wl Sllt Fence installed, <br /> Sanitary Facilities&1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance <br /> iIGN 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 aver$7500) <br /> ti 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 AIC Fences(Plot/Survey/Footage) <br /> Driveways-Not over Counter if.on public roadways..needs ROW <br />