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°"-'°`�""`u C:ity ot Lephyrhills Permit Application Fax-813-780-0021 <br /> Building Department <br /> Date Received — — r Z phone Contact for Permfttin <br /> Owner's Name � `�, O k✓ z � �' <br /> 9 COwner Phone Number ��3 7 � <br /> Owner's Address � (/' Owner Phone Number —1 <br /> Fee Simple Titleholder Name Owner Phone Number —� <br /> Fee Simple Titlehoider Address <br /> JOB ADDRES3 " l � / ( ( � �/ LOT# � <br /> SUBDIVISION PARCEL ID� <br /> (08TAINEO FROM PROPERTY TAX NOTICE) <br /> 1NORK PROPOSED B NEW CONS7R 8 ADD/ALT �� SIGN Q Q DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SFR Q COMM � OTHER <br /> TYPE OF CONSTRUCTION Q BLOCK Q FRAME � STEEL Q <br /> DESCRIPTION OF WORK � � ,.�� ! � <br /> BUILDING SIZE SQ FOOTAGE C� HEIGHT <br /> QBUILDING S VALUATION OF TOTAL CONSTRUCTION <br /> �ELECTRICAL a a��op AMP SERVICE [� PROGRESS ENERGY Q W.R.E.0 <br /> QPLUMBING a <br /> QMECHANICAL a VALUATION OF MECHANICAL INSTALLATION <br /> OGAS 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 /> Address License# <br /> ELECTRICIAN _,� COMPANY �q�'�•'1 t�/ �.. <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address �v � License# �-�3a �� <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 license# <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 aRer submittal date. Required onsite,Construction Plans,Stormwater Plans w1 Silt Fence installed, <br /> Sanitary FadllUes 8 1 dumpster;Site Worlc Permit for subdivisions/large projects <br /> COMMERCIAL Attach(3)complete sets of Bufiding 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,Co�shuction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Fac(Iities 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 consUuctlon. <br /> DirecHons: <br /> Ffll out appNcaHon oompletely. <br /> Owner&Contractor sign back of application,notaNzed <br /> If over i2S00,a Notice oi Commencement is required. (A!C upgrades over 57500) <br /> •' Agent(tor fhe 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(PIoUSurvey/Footage) <br /> Drivewaya-Not over Counter if on public roadways..needs ROW <br />