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813 -780 -0020 City of Lephyrhills I-'ermit Application rax :s1s - su - uuzi <br /> Building Department \ t k <br /> Date Received — 6 Phone Contact for Permitting I( ) 9/7 -- 96 4 <br /> Owner's Name ' 1C.k 0 CCU Q c-c, s Owner Phone Number a I. - "" %4 92- <br /> Owner's Address ? 3 a4 12.' Owner Phone Number <br /> Fee Simple Titleholder Name . I Owner Phone Number I <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS 3� 4 1 . 1 ' v-A LOT # <br /> SUBDIVISION . PARCEL ID# <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED NEW CONSTR r4, ADD /ALT I I SIGN n I-I DEMOLISH <br /> INSTALL MI REPAIR <br /> PROPOSED USE I-1 SFR n COMM I I OTHER I I <br /> TYPE OF CONSTRUCTION n BLOCK n FRAME I I STEEL n ( I <br /> DESCRIPTION OF WORK ( -- (2( :' (2( :' E -- =J--. <br /> c <br /> BUILDING SIZE � X 3' SQ FOOTAGE QOj HEIGHT I 1 c <br /> L TT °� 1 BUILDING $ l 4"16( Q W VALUATION OF TOTAL CONSTRUCTION <br /> N <br /> [ ( ELECTRICAL $ AMP SERVICE I I PROGRESS ENERGY n W.R.E.C. <br /> [ — I PLUMBING $ ,fi <br /> N <br /> [ (MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION <br /> nGAS [ ROOFING [-I SPECIALTY I I OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZREA nYES NO <br /> AI <br /> .._ : : _ ' \ ' COMPANY �t 1 1--+ 1� ��� "1 <br /> BUILDER <br /> SIGNATUR -- -. -- - - - — — - REGISTERED I Y / N I FEE CURRE1 I Y / N I <br /> Address 1 (..p 1S4 ''CJ0 • „_ � ii, License # I I <br /> ELECTRICIAN COMPANY <br /> SIGNATURE _ REGISTERED I Y/ N I FEE CURRE' I Y/ N I <br /> Address 1 License # I <br /> PLUMBER COMPANY <br /> SIGNATURE REGISTERED I Y/ N I FEE CURREa I Y/ N I <br /> Address I 1 License # I <br /> MECHANICAL COMPANY <br /> SIGNATURE REGISTERED I Y/ N I FEE CURREF I Y/ N I <br /> Address I 1 License # I I. <br /> OTHER COMPANY <br /> SIGNATURE REGISTERED I Y/ N I FEE CURREA I Y / N I <br /> Address I License # I <br /> RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (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 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 $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 (Front of Application Only) <br /> Reroofs if shingles Sewers Service Upgrades NC Fences (Plot/Survey /Footage) <br /> Driveways -Not over Counter if on public roadways..needs ROW <br />