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813-780-0020 City ot Lephyrhills rermit Applicat�on rax <br /> Building Department _ ---- _ .-- R--=----.__� _. <br /> %' <br /> Date Received 1 � l �, _ 3 0� � - � <br /> Phone Contact for Permittin <br /> Owners Name � Owner Phone Number � t��(� 3 <br /> Owner's Address � Owner Phone Number <br /> Fee Slmple Titleholder Name Owner Phone Number <br /> Fee 5imple Titleholder Address <br /> JOB ADDRESS v� I � C LOT # � <br /> SUBDIVISION , PARCEL ID# � � � �� ��� 1 � �� � � l � ��v ��� <br /> (OBTAINED FROM PROPERTY TAX NOTICEj <br /> WORK PROPOSED e NEW CONSTR B ADD/ALT Q SIGN Q Q DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SFR Q COMM � OTHER <br /> TYPE OF CONSTRUCTION BLOCK Q FRAME � STEEL Q <br /> , ,\n` � -�^ <br /> DESCRIPTION OF WORK W��-�' n JKX) I �m�1�1 I�s inS�"4 �( ��<'-r-�T�'u <br /> 1 n$'f`Q � � ° C �C /� S 9�� <br /> BUILDING SIZE —� SQ FOOTAGE � HEIGHT <br /> [�]BUILDING $ � VALUATION OF TOTAL CONSTRUCTION <br /> � ��-�C/, � <br /> QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C. <br /> .,.,,, <br /> LUMBING $ r�ti� °t� JACQU L!NF P;)G <br /> =*e • io; � # � E �1�;;': �+.: <br /> e cxu:��t'� s.' 2f'�14 <br /> OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION „�;ti...�e .�,��-•:. ��-:, .��� <br /> O r s c:�GVµ'""i . <br /> QGAS Q ROOFING Q SPECIALTY � OTHER ��Z� _�,,e< 7�� <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO � �A�� <br /> BUILDER ,� COMPANY <br /> SIGNATURE ��/ v REGISTERED Y/ N FEE CURREP Y/ N <br /> Address ' License # <br /> E CTRICIAN Y COMPANY <br /> NATURE REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address �' License # <br /> c <br /> LUMBER COMPANY <br /> NATURE 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 onslte, Constructlon Plans, Stormwater Plans w/ Sflt Fence Installed, <br /> Sanitary Facilitfes 8 1 dumpster; Slte Wo�ic Permit for subdivisions/large projects <br /> COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R-O-W Permit for new wnstruction. <br /> Minimum ten (10) working days after submittal date. Required onsite, Construction Ptans, Stormwater Plans w/ Silt Fence installed, <br /> Sanitary Facilities 8 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance <br /> SIGN PERMIT Attach (2) sets of Engineered Plans. <br /> "'*PROPERTY SURVEY required for all NEW construction. <br /> Directions: <br /> Fill out application completely. <br /> Owner 8� Contractor sign back of application, notarized <br /> If over 52500, a Notice of Commencement Is required. (A/C upgrades over 57500) <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 PERMIITING (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 />