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813-780-0020 City ot Lephyrhilis Nermit App�ication /�� / rax-ssis-iuu-uuz� <br /> Building Department f �'i e' <br /> ! �<< �s�t ��h� �� � i is3 S <br /> � , <br /> Date R�eived � �� i�� phona �ontact � Permittin �/3 7f L— — 3 3/ 9' <br /> Owner's Name �oS�C r / r�l h e Owne� Phone Number /3 '��" OG �i/3 <br /> Owner's Address �i /D D i9 r!" i r�,S� 2 /i{i /�f `/ Owner Phone Number � � <br /> Fee Simpie Titleholder Name Owner Phone Number � <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS LOT # � <br /> SUBDIVISION � , PARCEL ID# <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED NEW CONSTR ADD/ALT Q SIGN Q Q DEMOLISH <br /> B INSTALL 8 REPAIR <br /> PROPOSED USE Q SFR Q COMM � OTHER <br /> TYPE OF CONSTRUCTION Q BLOCK Q FRAME Q STEEL Q <br /> DESCRIPTION OF WORK /P /� E�/tc �t /�� s�o �cc E�� <br /> BUILDING SIZE �-� SQ FOOTAGE � HEIGHT <br /> QBUILDING $ VALUATION OF TOTAL CONSTRUCTION <br /> [�ELECTRICAL $ v AMP SERVICE /SO Il � ` PROGRESS ENERGY Q W.R.E.C. <br /> IJO <br /> QPLUMBING $ <br /> QMECHANICAL �� VALUATION OF MECHANICAL INSTALLATION <br /> OGAS Q ROOFING Q SPECIALTY Q OTHER <br /> FINISHED FLOOR ELEVATtONS FLOOD ZONE AREA QYES NO <br /> BUILDER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address ' License # � <br /> ELECTRICIAN �� ) p COMPANY /Q 7'�"/ r���c �r i c <br /> 51GNATURE �L �7 (���`+ � REGIS7ERED Y/ N FEE CURRE� N <br /> Address // I f H�l t Kd' � i1���s /� License # � �.' ' ��� ��� <br /> PLUMBER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N ' <br /> Address License # � <br /> MECHANICAL COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address License # � � <br /> OTHER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address L(cense # <br /> RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permit for new construcGon,. <br /> Minimum ten (10) working days after submittal date. Requfred onsite, Constructlon Plans, Stormwater P�ans w/ Silt Fence installed, <br /> Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects <br />