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s�3-780-002o City ot Lephyrhills Nermit Appucation rax-uis-iuu-uuzi <br /> , Building Department <br /> Date Recelved Phone Contact for Permittin — <br /> t <br /> Owner's Name �' � �l s' Owner Phone Number <br /> Owner's Address G� � Owner Phone Number <br /> Fee Simpie Titleholder Name � � Owner Phone Number <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS + � �� � � • (� RI OT # � <br /> SUBDIVISION � � PARCEL ID# <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED B NEW CONSTR 8 ADD/ALT � 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 � `. <br /> BUILDING SIZE � � SQ FOOTAGE � HEIGHT <br /> QBUILDING $ VALUATION OF TOTAL CONSTRUCTION <br /> QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C. <br /> PLUMBING $ <br /> �'�. - j .�C� � <br /> QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION ��( <br /> QGAS Q ROOFING Q SPECIALTY Q OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO <br /> BUILDER COMPANY <br /> SIGNATURE REGISTERED 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 Si<°l � ' �� <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 Ucense # � <br /> OTHER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address License # � <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, ConstrucUon Plans, Stormwater Plans w/ Silt Fence installed, <br /> Sanitarv Facilities 8 1 dum�ster: Site Work Permit for subdivislons/larae oroiacis <br />