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813 - 780 -0020 City of Lepflyrnllis rel I I Ill typituctuvii <br /> Building Department 41113-7 <br /> Date Received — 5 - 1 L Phone Contact for Permitting Y..? 70 -- 5319 <br /> P; �„ -s /, / 0 T'° er ` / /./ id& Owner Phone Number c) 8Y 791 0� <br /> Owner's Name 1�(�+ �+ / <br /> Owner's Address I 3 ! 7/3 j . [ � , H/ £ C, I Owner Phone Number I <br /> Fee Simple Titleholder Namel <br /> Owner Phone Number 1 <br /> Fee Simple Titleholder Address I �j r� /' [�� I I 9d <br /> JOB ADDRESS 1 d l 7/3 toy th // Lev, LOT # ,gyp <br /> I /771- $�yl (70.,4 /'�-/ I PARCEL ID #) 0 7- P 4 - 1) 1 d dcV - OO /G dv7 c <br /> SUBDIVISION (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED 1 S NEW CONSTR I I ADD /ALT 1 I SIGN 1 1 MOVE I 1 DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE I I SFR I I COMM I I OTHER I I <br /> TYPE OF CONSTRUCTION 1 I BLOCK I I FRAME I I STEEL I I OTHER I <br /> DESCRIPTION OF WORK 1 6-lcar court v itil - " r - ar 1 ark-r I <br /> BUILDING SIZE / 7 I X 7 3 / SQ FOOTAGE I CO O() P I HEIGHT <br /> WI BUILDING $ / y' Fe VALUATION OF TOTAL CONSTRUCTION <br /> It ELECTRICAL $ 1, 9s of AMP SERVICE 1 1 PROGRESS ENERGY 1 I W.R.E.C, <br /> I <br /> I I PLUMBING $ PASCO PERMIT SERVICE <br /> (813) 788 -5314 <br /> I I MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION F „ 1-886.824 -7894 <br /> I I GAS 1 1 ROOFING 1 1 SPECIALTY I 1 OTHER <br /> 0 °..--) <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA 1 IYES I 'NO <br /> t 1/411-1-4 vs4 4 �-, • -=�G <br /> BUILDER �j�(�� )�/ 1 COMPANY <br /> SIGNATURE CjC-� 1 4��6' -'&) REGISTERED I Y/ N I FEE CURRENT I Y / N I <br /> Address & /Sy Aryl- ∎ec Z—Aiiifr License # <br /> ELECTRICIAN ,,c` ��, /� ` ��� k , 0v COMPANY , VON4 4 8 • <br /> SIGNATURE �� r vw , / ' e W , REGISTERED • I Y / N I FEE CURRENT I Y / N 1 <br /> Address / • 0 . /80Y XS &A/ °' License # <br /> PLUMBER COMPANY <br /> SIGNATURE REGISTERED [ Y/ N I FEE CURRENT 1 Y/ N 1 <br /> Address License # <br /> MECHANICAL COMPANY <br /> SIGNATURE REGISTERED L Y / N I FEE CURRENT I Y / N 1 <br /> Address License # <br /> OTHER COMPANY <br /> SIGNATURE REGISTERED L Y / N 1 FEE CURRENT I Y / N I <br /> Address License # F <br /> RESIDENTIAL 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 wl Silt Fence installed, <br /> Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions /large projects <br /> COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R-0-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 /> SIGN PERMIT Attach (2) sets of Engineered Plans. <br /> * ** *PROPERTY SURVEY required for all NEW construction. <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 $5000) <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 (Front of Application Only) <br /> Reroofs Sewers Service. Upgrades NC Fences (Plot/Survey /Footage) <br /> Driveways -Not over Counter if on public roadways..needs ROW <br />