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�,o-�ou-uu�u C:ity ot Lephyrhilis Permit A lication <br /> PP Fax-813-780-0021 <br /> , „ Building Department <br /> Date Received <br /> Phone Contact for Permittin • __ q� <br /> Owner's Name �' �� ,P ,f, <br /> Owner Phone Number �]�j�, Q� � <br /> Ouvner's Address <br /> C� Owner Phone Number <br /> Fee Simple Titlehoider Name (� <br /> Owner Phone Number � <br /> Fee Sfmple Titleholder Addresa <br /> JOB ADDRESS I� � ��l - � J�S� � <br /> LOT# <br /> SUBDIVISION f � a� PARCEL ID!! (()'aI S�, <br /> �i o�� •CC�`�t U <br /> B (OBTAINED FROM PROPERTY TAX NOTICE) <br /> V1/0RK PROPOSED NEW CONSTR ADD/ALT SIGN <br /> INSTALL 8 REPAIR � ��� 0 DEMOLISH <br /> PROPOSED USE � SFR Q COMM OTHER <br /> TYPE OF CONSTRUCTION `� BLOCK Q FRAME C� STEEL � <br /> __� <br /> DESCRIPTION OF WORK I�A-E� � •S �,,,� — <br /> ,' � <br /> BUILDING SIZE SQ FOOTAGE� HEIGHT <br /> �]BUILDING $ <br /> � -- VALUATION OF TOTAL CONSTRUCTION <br /> QELECTRICAL $ AMP SERVICE � PROGRESS ENERGY [� W.R.E.0 <br /> OPLUMBING a <br /> � � �5�� � <br /> OMECHANICAL S VALUATION OF MECHANICAL INSTALLATION <br /> QGAS � ROOFING O SPECIALTY �� OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD 20NE AREA QYES NO /? 3�� <br /> ��r <br /> BUILDER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Addreas License# —� <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 /> Address License# �— —� <br /> IYIECHANICAL COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# � <br /> OTHER �� COMPANY <br /> SIGNIATURE REGISTERED Y/ N FEE CUR Y/N <br /> Address � `� Ze. �-c. 33�1 ) License# ��, �,� ��� <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of Bu(Iding Plans;(1)set of Energy Forms;R-O-W Permit for new construction, <br /> Minimum ten(10)wotking days aRer submittal date. Required ansite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Fadlitles 8 1 dumpster,Site Work Permit for subdivisionsAarge 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)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities&1 dumpster.Site Work Permft 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 consVucUon. <br /> -.�����,�,��*„��,������... <br /> Directions. "i'''"" <br /> Fill out application completely. <br /> Owner 8 Contractor sign back of applicatlon,notarized <br /> If over i2500,a Notice of Commencement is required. (AIC 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 Applicatlon Only) <br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoVSurveylFootage) <br /> DNvewaya-Not over Counter if on pubNc roadways..needs ROW <br />