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813-780-0020 City ot Lephyrhills Nermit Appilcation rax <br /> . Building Department <br /> Date Received - �� -� �� Phone Contact for Permittin � 7 _� � <br /> Owner's Name �� �'N Owner Phone Number 13' �a J" y <br /> Owner's Address �a / �2_ Owner Phone Number �— <br /> Fee Simple Titleholder Name � Owner Phone Number � <br /> Fee Simple Tltleholder Address <br /> JOB ADDRESS �� � S g / � ��N� !(,(�?(,L �,. ? j � LOT # �(�J <br /> SUBDIVISION � , PARCEL ID# <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED NEW CONSTR ADD/ALT � SIGN [� [� DEMOLISH <br /> INSTALL e REPAIR <br /> PROPOSED USE Q SFR Q COMM � OTHER � NG� W� p� ' <br /> TYPE OF CONSTRUCTION Q BLOCK Q FRAME C� STEEL Q I — 1 <br /> DESCRIPTION OF WORK O N C� 'S �� - � S�' � <br /> BUILDING SIZE � SQ FOOTAGe� `'! J HEIGHT � <br /> QBUILDING $ I� �� VALUATION OF TOTAL CONSTRUCTION <br /> ! <br /> QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY [� W.R.E.C. <br /> QPLUMBING � <br /> QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION <br /> QGAS Q ROOFING Q SPECIALTY � OTHER <br /> FINISHED FLOOR ELEVATIONS � FLOOD ZONE AREA �YES NO <br /> BUILDER , COMPANY �+�tD•� lN� ��... •�`,v��' <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address ,3S /�oo.cu✓�s CorE 1M, License # r � <br /> ELECTRICIAN COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address License # r —� <br /> PLUMBER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N � <br /> Address License # � <br /> MECHANICAL COMPANY <br /> SICaNATURE REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address License # � <br /> OTHER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address Llcense # �— <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, Constructlon Pians, Stormwater Plans wl Silt Fence installed, <br /> ^^����'^^, _, Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/larae oroiects <br />