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n,.r�ou-uu�u C:iry ot Lephyrhills Permit A lication <br /> PP Fax-813-780-0021 <br /> � Building Department <br /> Date Received � � <br /> Phone Contact for Permittin f � _�?>� <br /> Owners Name � � <br /> Owner Phone Number <br /> Ovnner's Address 5 � "f� <br /> Owner Phone Number <br /> Fee Simple Titleholder Name <br /> Owner Phone Number <br /> Fee Simple Tltleholder Address <br /> JOB ADDRESS tt, �� <br /> LOT� <br /> SUBDIVISION PARCEL ID* f�Z ��,f—d0 I D— <br /> �� ot�-a/ 90 <br /> WORK PROP03ED B (OBTAINED FROM PROPERTY TAX NOTICE) <br /> NEW CONSTR ADD/ALT C� SIGN [� [� DEMOLISH <br /> INSTALI REPAIR <br /> PROPOSED USE Q SFR Q COMM C� OTHER <br /> TYPE OF CONSTRUCTION � BLOCK � FRAME C� STEEL � <br /> DESCRIPTION OF WORK , � , <br /> i c- c,�i'c e <br /> BUILDING SIZE SQ FOOTAGE <br /> NEIGHT <br /> QBUILDING $ <br /> VALUATION OF TOTAL CONSTRUCTION <br /> C�/ LECTRICAL $ OD� AMP SERVICE /1S �pROGRESS ENERGY <br /> 0 W.R.E.0 <br /> QPLUMBING a ���� <br /> / <br /> �MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION -i ' I <br /> [�]GAS Q ROOFiNG Q SPECIALTY <br /> �] OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA <br /> QYES NO <br /> BUILDER COMPANY <br /> SIGNATURE <br /> REGISTERED Y/ N FEE CURRE� Y/N <br /> Addreas <br /> License# <br /> ELECTRICIAN C�'� COMPANY Y�tL <br /> SIGNATURE REGISTERED Y/ N FEE CURREA Y/N <br /> Address � ��ODb/�-----� <br /> License# a <br /> d�-- <br /> PLUMBER COMPANY <br /> SIGNATURE <br /> REGISTERED Y/ N FEE CURREP Y/N <br /> Address License# —� <br /> Al1ECHANICAL COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address <br /> License# <br /> OTHER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address <br /> License# <br /> RESIDENTIAL Attach(2)Piot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-0.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 Facilities&1 dumpster;Site Work Permit for subdivislons/large projects <br /> COMMERCIAL Attach(3)complete sets of 8uflding Pians plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permtt for new construction. <br /> Minimum ten(10)working days after submittal date. Required onsite,Construction Pians,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities&1 dumpster.Site Work Permit for all new projects.All commerciai requirements must meet compiiance <br /> SIGN PERMIT Attach(2)sets of Engineered Plans. <br /> """PROPERTY SURVEY required for all NEW constructlon. <br /> Directions: <br /> Fil�out application completely. <br /> Owner 8 Contractor sign back of appNcadon,notarized <br /> .• If over 52500,a Notice of Commencement is requfred. (AIC upgrades over 57500) <br /> Agent(tor 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 AppUcaHon Only) <br /> Reroots if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage) <br /> Driveways-Not over Counter if on public roadways..needs ROW <br />