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813-780-0020 City ot Lephyrhills Nermit Application rax-u�s-irsu-uuz� <br /> � Building Department / <br /> Date Rec�:ived , �/ <br /> �� ~�5 � Phone Contact for Permittin _ <br /> Owners Name /7�,.��� ��',� ,�,(,�_ Owner Phone Number <br /> Owner's Address �� // !� � /�3�'y� Owner Phone Number —� <br /> Fee Slmple Titleholder Name Owner Phone Number r � <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS �� ��'' // �il �' ���`z LOT# C� <br /> SUBDIVISION _ , PARCELID# 1����'2�'d�� ��'G�CJ'��G7v <br /> (OBTAINED FR�OM pROPERTY T�ncE)DEMOLISH <br /> WORK PROPOSED NEW CONSTR ADD/ALT [� SIGN <br /> INSTALL � REPAIR <br /> PROPOSED USE Q SFR Q COMM Q OTHER <br /> TYPE OF CONSTRUCTION Q BLOCK [� FRAME �� STEEL � <br /> DESCRIPTION OF WORK �iC.-� /<f�t'iC�„('7� y'.� �Oi� <br /> BUILDING SIZE �— � SQ FOOTAGE�� HEIGHT <br /> QBUILDING $ —� <br /> VALUATION OF TOTAL CONSTRUCTION <br /> QELECTRICAL �� AMP SERVICE Q PROGRESS ENERGY � W.R.E.C. <br /> QPLUMBING $ '' <br /> // � <br /> �AECHANICAL VALUATION OF MECHANICAL tNSTALLATION ��� �v <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 CURREP Y/N <br /> Address ' License# r <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 /> Add�ess License# <br /> MECHANICAL %- COMPANY � �1 !� �1���.�> <br /> SIGNATURE REGISTERED N FEE CURRE� <br /> Address GS� r ��� � � �� License#��% �Q�G <br /> r <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 wnstruction,. <br /> Minimum ten(10)working days after submittal date. Required onsite,ConstrucUon Plans,Stormwater Plans w/Silt Fence lnstalled, <br /> Sanitary Facilities 8 1 dumpster;S(te Work Permit for subdivisions/large projects <br /> COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction. <br /> Minimum ten(10)worlcing days after submittal date. Required onsite,ConstrucGon Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary FaciUties&1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance <br /> SIGN PERMIT Attach(2)sets of Englneered Plans. <br /> ""'PROPERTY SURVEY requlred for all NEW construcUon. <br /> Directions: <br /> Fill out application completely. <br /> Owner&ConFractor sign back of applicatlon,notarized <br /> If over;2500,a Notice of Commencement Is required. (A/C upgrades over;7500) <br /> " Agent(for 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 Application Only) <br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage) <br /> Driveways-Not over Counter if on pabllc roadways..needs ROW <br />