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a�saso City ot Lephyrhills Nermit Appllcation rax <br /> Building Department ,,,/� j/s"'2 7,. <br /> f�f" l J <br /> Date Recefved - � Phone Contact for Permittin - -� �� <br /> Owner's Name � D� I.S h I^/l � v1 c(/t Gi ✓ Owner Phone Number <br /> Owner's Address � 1 3 �� v+� C(� fi{ �✓.2 ��� � r� vf `�' Owner Phone Number <br /> Fee Simpie Titleholder Name �— Owner Phone Number <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS I/ L �t C' L� V �tv� LOT # � <br /> SUBDIVISION , PARCEL ID# ��ZS - (jU�O "OUi�b - pp ` - �j <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED B New coNSTR e ADD/ALT 0 SIGN Q Q DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SFR Q COMM Q OTHER <br /> TYPE OF CONSTRUCTION Q BLOCK Q FRAME Q STEEL Q <br /> DESCRIPTION OF WORK �-t= U � O,/� N� �} , - � - '1,� �� ~ 1 �(,� �„�►� � � �h (AZy �e ",� � H` / y <br /> BUILDING SIZE � � SQ FOOTAGE �� HEIGHT <br /> QBUILDING $/ J�L1 �J v iJ VALUATION OF TOTAL CONSTRUCTION <br /> G% <br /> QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C. <br /> QPLUMBING $ <br /> QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION <br /> QGAS � ROOFING Q SPECIALTY � OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO <br /> BUILDER COMPANY <br /> SIGNATURE REGISTEREO Y/ N FEE CURRE� Y/ N <br /> Address ' License # <br /> ELECTRICIAN COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address License # � —� <br /> PLUMBER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N � <br /> Address Llcense # �— � <br /> MECHANICAL COMPANY <br /> SIGNATURE _ REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address Ucense # <br /> SIGNATURE �/ I�ly .. � COMPANY t � ' f'!C. � �z j ` � '` " <br /> REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address �L� �� ^X ��� S� ``� i� I� e l.tcense #�� � V S 7%,s � <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 Plans, Stormwater Plans w/ Silt Fence installed, <br /> SaNtarv Facilities 8 1 dumnstpr• ctto w�.� ao�.,,�t s,,. �,��„a:.,���,,..��.._,.,. .._.�,.,,... <br />