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o,o-��u-uu�u C;ity ot Lephyrhills Permit Application Fax-813-780-0021 <br /> Buflding Department � 2'�� <br /> J`� <br /> Date Received Phone Contact for Permittin -- <br /> Owner's Name F-��Z f�% � � Owner Phone Number <br /> Ouvner's Address � c����r� �Owner Phone Number <br /> ��� ( � <br /> Fee Simple Titleholder Name Owner Phone Number <br /> Fee Simple Titleholder Addresa <br /> JOB ADDRESS (o[� �+� 't' LOT# � <br /> SUBDIVISION PARCEL ID# <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> 1NORK PROPOSED e NEW CONSTR B ADD/ALT Q SIGN Q Q DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SFR Q COMM Q OTHER <br /> TYPE OF CONSTRUCTION Q BLOCK Q FRAME Q STEEL Q <br /> t <br /> DESCRIPTION OF WORK -�.> )(n C+� � <br /> BUILDING SIZE SQ FOOTAGE � � HEIGHT <br /> QBUILDING 3 � r VALUATION OF TOTAL CONSTRUCTION <br /> . <br /> QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.0 <br /> �PLUMBING �� <br /> OMECHANICAL a VALUATION OF MECHANICAL INSTALLATION <br /> QGAS � ROOFING SPECIALTY � OTHER <br /> FINiSHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO <br /> BUt � , �{� (�' �._.c i�- COMPANY a�wt jc�r r- �ac����, 4 �s..��- <br /> 5�����,,,, av.�.l ��� c.✓ 0.-�7 0-�� REGISTERED Y N FEE CURRE� Y/N <br /> �;. <br /> Address S�`'ti q Crw�� �v d 7h.��S r�� � License# � 1� <br /> ELECTRICIAN COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# � <br /> PLUMBER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURREA 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 after submittal date. Required onsite,Construction Plans,StoRnwater P►ans w/Silt Fence installed, <br /> Sanitary Fadlitles�1 dumpster;Site Work Permit for subdivisionsllarge projects <br /> COMMERCIAL Attach(3)complete sets of Buildfng 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,Construction Plans,Stormwater Plans w!Silt Fence installed, <br /> Sanitary Facilities&1 dumpster.Site Work Pennit 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 consUuction. <br /> DirecHons: <br /> Fill out application completely. <br /> Owner�Contractor sign back of applicatlon,notarfzed <br /> If over i2500,a Noti �r�MwiA�idlslMll�'d:��I�C'�►adea over;7500) <br /> •• Agent(for the contract )or Poyrer af AttOt+tey(for the aw�er)woul e someone with o z d letter from owner authorizing same <br /> OVER THE COUNTER PE k7TINC3 (Front oflfpp�i,�tlon�niy) ��"�""�"'"''� <br /> Reroofs if shingles S ' Service Upgrades NC Fences(PIoUSurveylFo ge) <br /> Oriveways-Not over public roadways..needs ROW ,� <br /> a; _ <br /> ' c <br /> l <br /> ✓ '\ <br />