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a�saso-oozo City ot Lephyrhills Nermit Application FeJC-l313-73i�-0021 <br /> Building Department <br /> r <br /> Date Received phons Contact for Pennittin — <br /> �Owner's Name � JQ� r! L r Owner Phone Number d� �� ..� 7 yn <br /> qwners Address C� / 7� /O �iT� Z hfi��� �Owner Phone Number <br /> �� <br /> Fee Simple Titleholder Name Owner Phone Number <br /> Fee Simple Titleholder Address <br /> �B ADDRESS � �1 � ) O �� r�L��l 2 °��! I/S � . ,� � � � <br /> SUBDIVISION � , PARCEL ID# <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED e NEW CONS7R B ADD/ALT Q SIGN �J Q DEMOLISH � <br /> INSTALL REPAIR <br /> PROPOSED USE �] SFR Q COMM � OTHER <br /> TYPE OF CONSTRUCTION BLO K Q FRAME � STEEL Q <br /> �pESCRIPTION OF WORI(�� � r Q, l�l Q Q�,Q, G � 1()y1r� �� �� �"0 �(�C. � <br /> f ` y� <br /> BUILDING SIZE �--� SQ FOOTAGE �� � � Z HEIGHT P�� � <br /> a,:� �.%� �e <br /> BUILDING $ �� VALUATION OF TOTAL CONSTRUCTION <br /> QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C. <br /> QPLUMBING $ <br /> OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION �� <br /> l <br /> QGAS Q ROOFING Q SPECIALTY Q OTHER ��-R� <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO <br /> BUILDER � COMPANY �' � S --� � � <br /> SIGNATURE REGISTERED Y/ N FEE Cuwt�� Y/ N <br /> Address ' License # <br /> ELECTRICIAN COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N <br /> Address License # r <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 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, Constructlon Plans, Stormwater Plans w/ Silt Fence installed, <br /> Sanitary Facilities 8 1 dumpster; Site Wo�lc Permit for subdlvisions/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 construcUon. <br /> Mi�lmum ten (10) worlcing days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, <br /> Sanitary Facilities 8 1 dumpster. Site Work Permit for all new projects. All wmmercial requirements must meet compliance <br /> SIGN PERMIT Attach (2) sets of Engineered Plans. <br /> ""«PROPERTY SURVEY required fo� all NEW construcUon. <br /> TTTTrr��������r7�r����r���� <br /> �+� �LYlil 1 <br /> Directions. <br /> Fiit out application completely. <br /> Owner 8� Confractor slgn back of applica8on, notarized <br /> If over;2500, a Notice of Commencement is required. (A!C upgrades over iT500) <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 Applicatlon 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 />