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<br />813-780-0020 <br /> <br />City of Lephyrnllls l-'erml1l\ppllCaIlon ' QA-U hr' uu-vv.. I <br />Building Department ~A .s5 L.-.Jf Z'^!-!'i5'Y I <br /> <br />Owner's Name <br /> <br /> <br />~V\ <br /> <br /> <br />Owner Phone Number <br /> <br />Owner phone Number I <br /> <br />OWner Phone Numb~r I <br /> <br />Date Received <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Nam~ <br /> <br /> <br />JOB ADDRESS <br /> <br />SUBDIVISION <br /> <br />WORK PROPOSED <br /> <br />OTHER 1 <br /> <br />I <br />I. <br />I <br /> <br />D <br /> <br />W.R.E.C. <br /> <br />VALUATION OF MECHANICAL INSTALLATION <br /> <br />35- pa':, +. <br /> <br />S- &d..ADO <br />p~r":' ~. <br /> <br />SPECIALTY 0 <br />FLOOD ZONE AREA <br /> <br />OTHER <br />DYES <br /> <br />DNO <br /> <br />~~;~~~~"I"" ....... ..,....... ....,......... ......... .....,.... ...~;.~;. ...,..,. ~ :.~,...... :~~~.. ...... ~; ~...... ,.. ..,... 'I <br /> <br /> <br />Address I License # I <br /> <br />~~~~~~:"~ ~- ~ ~~=~ 1Z".((",.~61)-'f-y~,<- 1 <br /> <br />Address. c,)e..-C-f-.. ~ LIcense # I GLI5()O/'3YS I <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />PLUMBER <br />SIGNATURE <br /> <br />COMPANY <br />REGISTERED <br /> <br />Y/N <br /> <br />FEE CURRENT <br /> <br />Y/N <br /> <br />Address <br /> <br />License # <br /> <br />COMPANY <br />REGISTERED <br /> <br />MECHANICAL <br />SIGNATURE <br /> <br />Y I N <br /> <br />FEE CURRENT <br /> <br />Y/N <br /> <br />Address <br /> <br />LIcense # <br /> <br />I <br /> <br />OTHER <br />SIGNATURE <br /> <br />COMPANY <br />REGISTERED <br /> <br />Y/N <br /> <br />FEE CURRENT <br /> <br />Y/N <br /> <br />Address <br /> <br />License # <br /> <br />till' , r , , 111I11 I' 1111I1111 , , , I , 11II , 1111I11111I11111111111 , , 1 , III t , II , 11111111 t I , I . J 11111111111 , 1 , I , , 111II11I , II . 1111 , , , 111111111 r I . I111I1I , I , , , I <br /> <br />RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms <br />Minimum ten (10) working days after submittal date. Required onslte, Construction Plans, Sanitary Facilities & 1 dumpster <br />COMMERCIAL Attach (3) sets of Building Plans; (1) set of Energy Forms. <br />Minimum ten (10) working days after submittal date. Required onsile, Construction Plans, Sanitary Facilities & 1 dumpster <br />All commercial requirements must meet compliance. <br />SIGN PERMIT Attach (2) sets of Engineered Plans. <br />....PROPERTY SURVEY required for all NEW construction. <br />I'" ~ l ~ ~.I ~ 111.1.11 ~ I' II.. ~ 11111111111-111111111. ~ IIIIII.~ 11111III111111111 ~ I ~IIIIIIIIIIII i i III11I1IIII11111 i 111I111 i I1I1111 &-11111111111 i Iii III i II i i <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. (AlC upgrades over $5000) <br /> <br />Agent (for the contractor) or Power of Attomey (for the owner) would be someone with notarized letter from owner authorizing same <br /> <br />OVER THE COUNTER PERMITTING (Front of Application Only) <br />Reroofs Sewers Service Upgrades AlC Driveways Fences (PloU5urvey/Footage) <br />