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-- ---- uny or Lephyrhills Permit Application Fax-813-780-0021 <br /> Building Department <br /> Date Received Phone Contact for Permitting (�5b eGtai a lvZ C� C�t�I�Or�8n CAM <br /> Owners Name !� n r Owner Phone Number „_ _l.' {{ct <br /> Owner's Address 2 334 Owner Phone Number <br /> Fee Simple Titleholder Name Owner Phone Number_ <br /> Fee Simple Titleholder Address} <br /> JOB ADDRESS ` / / "�+CA° ! G ter _ LOT# <br /> SUBDIVISION1 PARCEL 1D# � "�� <br /> r (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED NEW CONSTRR ADD/ALT L.� SIGN 0 DEMOLISH <br /> F-i 'INSTALL REPAIR <br /> PROPOSED USE 0,,. •. SFR Q COMM OTHER d '�;/ f <br /> TYPE OF CONSTRUCTION L BLOCK FRAME 0 STEEL <br /> DESCRIPTION OF WORK -- <br /> BUILDING SIZE SQ FOOTAGE HEIGHT <br /> QBUILDlNG 0d, VALUATION OF TOTAL CONSTRUCTION <br /> =ELECTRICAL AMP SERVICE Q PROGRESS ENERGY 0 W.R.E.C. <br /> =PLUMBING 1$ � �. � �J'�--• . <br /> =MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION <br /> I <br /> =GAS C ROOFING 0 SPECIALTY OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO <br /> BUILDER 0 �,�,.�.�e''"" COMPANY I'1 <br /> SIGNATURE .... REGISTERED Y'/ N FEft CURRES Address, 12 O License# c%CCU 39'642' <br /> ELECTRICIAN > COMPANY . SCA <br /> SIGNATURE REGISTERED Y/ N FEE CURREN T7 N Address. r License# �a 639-13- <br /> PLUMBER COMPANY Pluto- <br /> SIGNATURE -� "� �—'� REGISTERED Y/ N FEE CURB A Yl N <br /> Address Z24100a 3361 Z- License# <br /> MECHANICAL COMPANY IQINAIV, <br /> SIGNATURE REGISTERED ( N FEE CU •Y/N / <br /> Address 5- 0. S3' License# V <br /> OTHER COMPANY G <br /> SIGNATURE REGISTERED Y/fN EE CUR N{ <br /> Address 3 Li se# � �. <br /> 11 ! lIIILtlllllflLlli.iiilillill ° I !. lIIIIII ( [ llllllltll ! ! ! ! I ! 1 ! 1 <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Farms;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 /> COMMERCIAL 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 Silt Fence installed, <br /> Sanitary Facilities&1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance <br /> SIGN PERMIT Attach(2)sets of Engineered Plans. <br /> ****PROPERTY SURVEY required for all NEW construction. <br /> - ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ r r ■ ■ ■ ■ t ■ ■ • ■ ■ ■ ■ • ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ r ■ L ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■'■ ■ <br /> - - - - - - - - - - - - - <br /> Directions: ' <br /> Fill out application completely. <br /> Owner&Contractor sign back of application,notarized <br /> If over$2500,a Notice of Commencement is required. (A/C 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 /> OVER THE COUNTER PERMITTING (copy of contract required) <br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(Plot/SurVey/Footage) <br /> Driveways-Not over Counter if on public roadways..needs ROW <br />