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es��a-rou-wzr� City ot Lephyrhills Permit Application rax-ai�-inu-uu�� <br /> Building Department <br /> Date Recelved _ � ��� <br /> , Phon�Cor�taot tor Permittfn <br /> Ox�rner's Idame , Owner Phone Number �) ' <br /> O�nmer's Addresa � Ovmer Phone Number <br /> Fee Simple Titlehotder Name Owner Phons Number <br /> Fee 3lmple Tttleholder Addros� <br /> JOB ADDRE33 � LOT N � <br /> 3UBDIVISIOfd �� V d PARCEL 1D# � �' ' <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> HHORK PROP03ED B NEW CONSTR� ADD/ALT 0 SIGN � 0 DEMO�ISH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SFR � COMM Q OTHER <br /> TVPE OF CQPI3TRUCTIOfd Q BLOCK � FRAME Q STEEL Q <br /> . � <br /> �ESCRIPTIOId OF WORK � � <br /> �UILDINQ SIZE -1 � SQ FOOTA(iE � � HEIOHT <br /> BUILDING $ �0�7-�/'2(�� VALUATION OF TOTAL CONSTRUCTfON <br /> � 1 �J-1 <br /> �L.ECTRICAL S �bO AMP SERVICE aO� Q PROGRESS ENERGY Q W.R.E.C. <br /> "�l.UM81NG 3 c'..JC�t, �`)\G �/U�..""_ <br /> �l v V I� �CGt4�1'lJ�'I Py�'- <br /> `�A/IECHANICAL a �3�� VALUATION OF MECHANICAL INSTALLATION �;J 3�"�I <br /> GA5 ' ROOFING SPECIALTY OTHER ���{��S 1 �r � � <br /> o t�- o c� ��� <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES Nd�, cl�� �bS <br /> �gU��,p�� ��Q,, COMPANY <br /> SIGRIATURE �" C�1.1�'v REGISTERED Y/ N FEE CURR Y/N <br /> Address �(L� � � � License`� �U���.� Z ��W � <br /> IELECTRICIAM r �� G����.J�� COMPANY , , <br /> SIGNATURE � REGISTERED Y/ N FEE CURRE� Y/N <br /> Addfess � � � License# �ce�ooa��-q —1 <br /> �LUMBER t J� � COMPANY <br /> SIGNATURE �"' v��� � REOISTERED Y/ N FEE CURRE� Y/N <br /> Addross �3 lli� Ltcense# ,r�' ,1!��c )U"l I <br /> MIECHANICAL COMPANY �� �� . . . ' � i'lit1C.�} ���'I � <br /> SIGMATURE "� ���- REGISTERED Y/ N FEE RE� <br /> ` �2�, / � � ��_� ��� �jZ7��� Ucense# . �J�,�Zn — <br /> Addross �J� l.. I���A, , -nu�k'�%1 ��... <br /> OTHER � � ~ �/ ' � COMPANY �� I <br /> SIGfdATURE �i REQISTERED Y/ N FEE CUR Y/N <br /> Address �� . �US `1 Llcense# (�-�-L.���1 � l <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Fonns;R-0.W PeRnit for new construction, <br /> Minimum ten(10)wvrking days after submittal data. Required onsite,Construction Plans,Stortnwater Plans w/Silt Fence installed, <br /> Sanitary Facilides�1 dumpster;Site Work Permit for subdtvislonsAarge projects <br /> COMIMERCIAL Attach(3)comptete sets of Building Plans ptus a Life Safety Page;(1)set of Energy Forms.R-O-W Pertnit for new conshuction. <br /> Minimum ten(10)working daya after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Fadlities 8 1 dumpster.Site Wor1c Permit for all new projects.Atl commerclal requirements must meet compUance <br /> SIGN PERMIT Attach(2)sets of Engineered Plans. <br /> •••'PROPERTY SURVEY required for atl NEW constructlon. <br /> ������i��1��1r11�11111f�1111'7 <br /> Directions: <br /> Fitl out appl(cation completely. <br /> Owner&Contractor s(gn back of appltcaUon,notarized <br /> N over f2500,a Notice of Commencement ia requtrod. (A1C upgrades over S7S00) <br /> •' Agent(for the contractor)or Power of Attomey(for the owner)woutd be someone wtth notarized letter from owner authorizing same <br /> OVER THE COUNTER PERMITTINf3 {Front of AppllcaUon Only) <br /> Reroofs if shingles Sewers Servtce Upgrades A/C Fences(PIoUSurvey/Footage) <br /> Drtvervays-Not over Counter if on public roadways..needs ROW <br />