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813 -780 -0020 City of Lephyrhills Permit Application i ax -b1.3- ibu -uuzi <br /> Building Department <br /> Date Received + �i EN D-0 i <br /> ( Phone Contact for Permittin e M1 <br /> Owner's Name "� / ? « ' ' ± 6- r_, S5 Owner Phone Number C 1 3 79S Lj - / C R3 <br /> Owner's Address I ) (') 9 Z C G , i j tti„ S. )1 „ , f Owner Phone Number I <br /> Fee Simple Titleholder Name . I Owner Phone Number I <br /> Fee Simple Titleholder Address , <br /> JOB ADDRESS 7 9- 1 �/ > -...„," rv, H 4 GIA.. r . LOT # S J q- <br /> SUBDIVISION , PARCEL ID# <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED NEW CONSTR _ ADD /ALT 1 I SIGN [1 ni DEMOLISH <br /> INSTALL _ REPAIR <br /> PROPOSED USE n SFR n COMM 1 I OTHER 1 <br /> TYPE OF CONSTRUCTION n BLOCK n FRAME 1 1 STEEL n 1 <br /> DESCRIPTION OF WORK IX 2; 112. ,,„: 1-70-c.k ,1,,,I� ,� ,..4.....j ) -,- p, f ,- <br /> BUILDING SIZE SQ FOOTAGE HEIGHT <br /> []BUILDING $ VALUATION OF TOTAL CONSTRUCTION <br /> FIXE $ • ate' AMP SERVICE 1 1 PROGRESS ENERGY 1 1 W.R.E.C. <br /> .L) D <br /> []PLUMBING $ <br /> 1-----i MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION I I <br /> 1 1GAS n ROOFING n SPECIALTY 1 1 OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA nYES NO <br /> BUILDER COMPANY <br /> SIGNATURE REGISTERED 1 Y/ N 1 FEE CURREN 1 Y/ N I <br /> Address I License # I I <br /> ELECTRICIAN \ � \ P-PAE t 1 =\fAC'- <br /> SIGNATURE _ �J V1. C 1 <br /> REGISTERED 1 Y/ N I FEE CURREN 1 Y/ N 1 <br /> Address 1 L 1 I ( C. * '\ 't 1 License # 1 Ec ( <br /> PLUMBER COMPANY <br /> SIGNATURE REGISTERED 1 Y/ N 1 FEE CURREN 1 Y/ N I' <br /> Address I 1 License # I <br /> MECHANICAL COMPANY I <br /> SIGNATURE REGISTERED 1 Y/ N 1 FEE CURREN 1 Y/ N 1 <br /> Address I 1 License # I I. <br /> OTHER COMPANY <br /> SIGNATURE REGISTERED 1 Y/ N I FEE CURREF 1 Y/ N 1 <br /> Address 1 License # i I <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 w/ 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 -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 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. (NC upgrades over $7500) <br /> ** Agent (for the contractor) or Power of Attomey (for the owner) would be someone with notarized letter from owner authorizing same <br /> OVER THE COUNTER PERMITTING (Front of Application Only) <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 />