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$�a City ot Lephyrhills Nermit Application Fax-813-78U-UU21 <br /> Building Department <br /> Date Recelved phone Contact for Permittin <br /> � _ <br /> Owner's Name Owner Phone Number �� r r ��n — � 7� <br /> Owner's Address � er Phone Number —� <br /> Fee Slmple Titleholder Name . Ownar 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 /> INSTALL e REPAIR <br /> PROPOSED USE Q SFR Q COMM 0 OTHER <br /> TYPE OF CONSTRUCTION Q BLOCK Q FRAME 0 STEEL Q <br /> DESCRIPTION OF WORK <br /> BUILDING SIZE SQ FOOT GE � HEIGHT <br /> QBUILDING $���.. VALUATION OF TOTAL CONSTRUCTION <br /> �i .,� <br /> QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY � W.R.E.C. <br /> QPLUMBING $ ') <br /> .� /��� <br /> QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION �� <br /> QGAS ROOFING SPECIALTY OTHER � <br /> � � � <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 <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 Llcense # <br /> OTHER � COMPANY <br /> SIGNATURE REGISTERED FEE CUR E� / <br /> Address L(cense # <br /> RESIDENTIAL Attach (2� Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-0-W Permit for new construction,, <br /> Minimum ten (10) working days after submittal date. Required onsite, Construcdon Plans, Stormwater Plans w/ Silt Fence installed, <br /> Sanitary FadliUes 8 1 dumpster; Site Work Permit for subdivisions/large projects <br /> COMMERCIAL Attach (3) complete sets of Bullding Plans plus a Life Safety Page; (1) set of Energy Forms. R-O-W Permit for new construction. <br /> Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, <br /> Sanitary FaGlities 8 1 dumpster. Site Work Permit for all �ew p�ojects. All commercial requirements must meet compliance <br /> SIGN PERMIT Attach (2) sets of Engineered Plans. <br /> ""'PROPERTY SURVEY required for all NEW construction. <br /> Dlrections: <br /> Fill out application completely. � <br /> Owner 8 Confractor sign back of application, notarized <br /> If over 52500, a Notice of Commencement is requlred. (A/C upgrades over:7500) <br /> '" Agent (for the contractor) or Power of Attomey (for the owner) would be someone with notarized letter from owner authorizing same <br /> OVER THE COUNTER PERMITTING (Front of Application Only) <br /> Reroofs if shingles Sewers Service Upgrades A/C Fences (Plot/Survey/Footage) <br /> Driveways-Not over Counter if on public roadways..needs ROW <br />