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°"-,°"'"""' c.:ity ot Lephymills Permit Appiication Fax-813-780-0021 <br /> Building Department <br /> Date Rrceived <br /> Phone C ntact for Permittin __ <br /> Owner's Name �� ` Owner Phone Number '.� � � , <br /> Owner's Addresa �. Owner Phone Number -� <br /> Fee Simple Titlehoider Name Owner Phone Number <br /> Fee 3lmple Tftleholder Addresa <br /> JOB ADDRESS LOT�t �� <br /> SUBDIVISION PARCEL ID* <br /> (OBTAINED F�pROPERTY TO�ce)DEMOLISH <br /> WORK PROPOSED NEW CoNS7R ADD/ALT [�� SIGN <br /> INSTALL B REPAIR <br /> PROPOSED USE Q SFR [] COMM [—� OTHER <br /> TYPE OF CONSTRUCTION Q BLO K FRAME STEE <br /> DESCRIPTION OF WORK � G v � �,. <br /> BUILDIN(3 SIZE SQ FOOTAGE�� HEIGHT <br /> QBUILDING S VALUATION OF TOTAL CqNSTRUCTION � <br /> �/ � �' <br /> QELECTRICAL � AMP SERVICE �� � �� � W.R.E.0 <br /> � PROGRES ERGY <br /> OPLUMBING s <br /> QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION �����;', <br /> � � C1 <br /> QGAS Q ROOFING Q SPECIALTY C] OTHER <br /> FINISHED FLOOR ELEVATIONS FLO00 ZONE AREA QYES NO <br /> BUILDER COMPANY <br /> SIGNATURE REGISTERED Y J N FEE CURRE� Y/N <br /> Address License# <br /> ELECTRICIAN /j��,�j�. � B ✓ COMPANY � ' / �/ G `L <br /> SIGNATURE (.1'/� v 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 /> Addross License# <br /> OTHER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y J N <br /> Addresa License# <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of 8uilding Pians;(1)set of Energy Forms;R-O-W Pennit for new construction, <br /> Minimum ten(10)woiicing days after submittal date. Requfred onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Fadlitles 8 1 dumpster;Site Wo�lc Pertnit for subdivisionsAarge projects <br /> COMMERCIAL Attach(3)complete sets of Building Plans plus a life Safey Page;(1)set of Energy Forms.R-O-W Permit for new construction. <br /> Minimum ten(10)w�aking days aRer submittal date. Required onsite,Construction Ptans,Stormwater Plans w!Silt Fence installed, <br /> Sanitary Fadfldes 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 requlred for all NEW construcUon. <br /> Directions: <br /> Fill out applicatlon completely. <br /> Owner 8 Contractor sign badc of applicatlon,notaNzed <br /> If over iZS00,a Notice of Commencement is required. (A!C upgrades over 57500) <br /> " Agent(for the contractor)or Power of Attomey(for the owner)vwuld be someone wtth notarized letter from owner authorizing same <br /> OVER THE COUNTER PERMITTING (Front of ApplicaUon Only) <br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(Plof/Survey/Footage) <br /> Drivewaya-Not over Counter if on public roadways..needs ROW <br />