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O 13-/OU-UULU c;itar ot Lephyrhills Permit Application Fax-813-780-0021 <br /> Building Department <br /> Date Received <br /> Phone Contact for Permittin __ <br /> Owner's Name ��`�! �� R - .�� � Owner Phone Number �� �a-D �d <br /> Owner's Address Owner Phone Number —1 <br /> Fee Simple Titleholder Name Owner Phone Number �— <br /> Fee 3lmple Titleholder Address <br /> JOB ADDRE33 � (� 3 � �a, ,. �� <br /> LOT#� <br /> SUBDIVISION PARCEL ID# <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> 1NORK PROP03ED e NEW CONS7R B ADD/ALT � SIGN Q Q DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SFR Q COMM � OTHER <br /> TYPE OF CONSTRUCTION [� BLOCK [� FRAME [-� STEEL �] <br /> DESCRIPTION OF WORK � � 07� G� �S sr.- �' �n �c1 �� <br /> BUILDING SIZE SQ FOOTA(3E HEIGHT <br /> QBUILDING a <br /> VALUATION OF TOTAL CONSTRUCTION <br /> QELECTRICAL � AMP SERVICE Q PROGRESS ENERGY [� W.R.E.C. <br /> OPLUMBING a • <br /> i / ✓f; '� � <br /> [�MECHANICAL `� ` � <br /> � 3��{ � VALUATION OF MECHANICAL INSTALLATI N E � � <br /> � j � <br /> QGAS Q ROOFING Q SPECIALTY �� OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO <br /> BUILDER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Addreas 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 Ltcense# �— —� <br /> MECHANICAL COMPANY �`N S Cg-�v i <br /> SIGNATURE REGISTERED Y/ FEE CURRE� Y/N <br /> Address Lfcense# ��Q�� —� <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 M Energy Forms;R-O-W Permit for new construction, <br /> Minimum ten(10)working days after submittal date. Requlred onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Fadlitles 8 1 dumpster;Site Work Permit for subdivisionsllarge projects <br /> COMMERCIAL Attach(3)complete sets of Buflding Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction. <br /> Minimum ten(10)working days aRer submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Fadlities 8 1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet complfance <br /> SIGN PERMIT Attach(2)sets of Englneered Plans. <br /> "'"PROPERTY SURVEY required for all NEW constructlon. <br /> Diroctiona: <br /> Fill out applicatlon completely. <br /> Owner 8 Contractor sign badc of appHcatlon,notarized <br /> If over t2500,a Notice ot Commencement is required. (A!C upgradea over 57500) <br /> " Agent(for the contractor)or Power of Attomey(for the owner)would be someone wfth notarized letter from owner authorizing same <br /> OVER THE COUNTER PERMITTING (Front of Applicatlon Only) <br /> Reroois if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage) <br /> Driveways-Not over Counter if on puWic roadways..needs ROW .. .. ...-. . . . ., _ ,,..... <br /> � <br />