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813-780-0020 City ot Lephyrhills Nermit AppUcation rax <br /> Buildinh Depar"L�ent <br /> Date Rece(ved Phone Contact for Permittin — <br /> '�-- 37 / � G! ` � _ � <br /> Owners Name �r2 � Owner Phone Number ���� .Z r <br /> Owner's Address ��� ����P Owner Phone Number <br /> Fee Simple 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 B NEW CONSTR � ADD/ALT � SIGN Q Q DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE � SFR Q COMM Q OTHER <br /> TYPE OF CONSTRUCTION BLOCK Q FRAME Q STEEL Q <br /> DESCRIPTION OF WORK � l<Jr-� � � �"" E.��� r,(� ��C � C� <br /> BUI�DING SIZE SQ FOOTAGE � HEIGHT <br /> OBUILDING $ VALUATION OF TOTAL CONSTRUCTION <br /> QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY � W.R.E.C. <br /> ele���� <br /> �PLUMBING $ ., (� �YtS � <br /> ' � � ✓ <br /> MECHANICAL $ .-� VALUATION OF MECHANICAL INSTALLATION� , G(C�t <br /> 0 s ozs�. �- <br /> � � <br /> QGAS Q ROOFING Q SPECIALTY Q OTHER O <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 � (v -rj� `r �- �. <br /> SIGNATURE � REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address License # �� ��7��� <br /> PLUMBER � COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address License # <br /> MECHANICAL COMPANY �"'S C..c�y.- �u/ l 2 p' �- <br /> SIGNATURE ' Re�isreRe� Y/ N FEE CURRE� Y/ N <br /> Address Ucense # � r ��2 <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 /> Sanitary Facilities 8� 1 dumpster; Site Work Permit for subdivisions/large projects <br />