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es�ia-iesu-w�u c;ity ot Lephymills Permit Appiication Fax-813-780-0021 <br /> Building Department <br /> Date Received Phone Co�tact for Pertnittin ��3 7$� __ d � <br /> Owner's Name ..��mC� � _ Ol.������{l Owner Phone Number ��3"700 '(77 /� <br /> Ovnner's Address ��O�l� ���r2.. '��1�`�S �`c..,' p�er Phone Number -1 <br /> Fee Simple Titleholder Name N � Owner Phone Number <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS ��S �� �(' ` � LOT# C� <br /> SUBDIVISION PARCEL ID# ��"� o�-� `O'I� <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED NEW CONSTR ADD/ALT � SIGN [� Q DEMOIISH <br /> INSTALL 8 REPAIR <br /> PROPOSED USE Q SFR Q COMM Q OTHER <br /> TYPE OF CONSTRUCTION Q BLOCK Q FRAME �� STEEL Q <br /> DESCRIPTION OF WORK <br /> BUILDING SIZE SQ FOOTAGE �2I�j HEIGHT <br /> QBUILDING S D rJ VALUATION OF TOTAL CONSTRUCTION <br /> QELECTRICAL � AMP SERVICE 0 PROGRESS ENERGY C] W.R.E.0 <br /> QPLUMBING $ ( <br /> OMECHANICAL a VALUATION OF MEC�IANICAL INSTALLATION � <br /> �� I � <br /> L�( ��r�C3 <br /> �� L./ <br /> QGAS �, ROOFING Q SPECIALTY � OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO <br /> BUILDER COMPANY � <br /> O � --L <br /> SIGNATURE REGISTERED Y J N FEE CU RE� Y/N <br /> Address Vy� ��� � � <br /> 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 /> 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 Athach(2)Plot Pla�s;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction, <br /> Minimum ten(10)woticing days after submi8al date. Required onsite,Construction Plans,Stormwater Pians w!Silt Fence installed, <br /> Sanitary Fadlides&1 dumpster;Site Wo►k Permit for subdivisions/large projects <br /> COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safey Page;(1)set of Energy Forms.R-O-W Permit tor new construction. <br /> Minimvm ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary FaciNdes&1 dumpster.Site Woiic Permit for all new projects.All commercial requirements must meet compliance <br /> SIGN PERMIT Attach(2)sets of Engineered Plans. <br /> """PROPERIY SURVEY required for all NEW consVuction. <br /> Directions: <br /> Fill out application completely. <br /> Owner 8 Contractor sign back of appHcatlon,nota►ized <br /> If over 52500,a Notice of Commencement la required. (A/C upgradea over 57500) <br /> •• Agent(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authori;ing same <br /> OVER THE COUN � rt� �(Front of Applicatlon�Jnly) .� <br /> Reroois if shingles Sewers Service Upgrades A/C � Fences(PIoUSurvey�ootage) <br /> Driveways-N er.�Counter if on publi�roa!lwaya,,�eeds�W - . � <br /> . :s:r.7;., -.^' �,,�,�,.,�,„,,, '� <br /> ,,,�,,,.{ -����, <br />