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a��-��u-uu�u Cit�ot[ephyrhills Permit Application <br /> Building Department Fax-813-780.0021 <br /> Date Received � <br /> Phone Contact for Permittin � �8 Q / <br /> . � <br /> Ov�ners Name ' I' � h �-�f_,L_L� <br /> Owner Phone Number <br /> Owner's Address ��,3� ��` <br /> Owner Phone Number <br /> Fee Simple Titleholder Name <br /> Owner Phone Number <br /> Fee Simple Tttieholder Address <br /> JOB ADDRESS G ' � /�}/�J� Z._�� 5� r�� LOT� <br /> SUBDIVISION �� <br /> PARCEL ID# g'" �� ° �� 'DD�O,rD��^^ ��T <br /> G.�'J c,.c,C,C/ <br /> 1MORK PROPOSED e (08TAINED FROM PROPERTY TAX NOTICE) <br /> NEW CONSTR ADD/ALT � SIGN � <br /> INSTALL REPAIR C� DEMOLISH <br /> F�ROPOSED USE Q SFR Q COMM <br /> TYPE OF CON3TRUCTION Q BLOCK � OTHER <br /> �] FRAME C� STEEL � <br /> DESCRIPTION OF WORK M1S�f� � � �QC S �"O^{' /�l r��� d e <br /> BUILDING SIZE SQ FOOTAGE C] <br /> HEIGHT <br /> QBUILDING a <br /> VALUATiON OF TOTAL CONSTRUCTION <br /> QELECTRICAL � AMP SERVICE <br /> �] PROGRESS ENERGY [� W.R.E.C. <br /> QPLUMBING $ <br /> QMECHANICAL s VALUATION OF MECHANICAL INSTALLATION � � J� <br /> QGAS Q ROOFING [] SPECIALTY �` I � <br /> Q OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA <br /> �YES NO L � LtJ.C� <br /> ��E� � I <br /> BUILDER <br /> SIGNATURE COMPANY <br /> REGISTERED Y/ N FEE CURRE� Y/N <br /> Address � <br /> License J� � <br /> ELECTRICIAN <br /> SIGNATURE COMPANY <br /> REGISTERED Y/ N FEE CURRE� Y/N <br /> Address <br /> License# � <br /> PLUMBER <br /> SIGNATURE COMPANY <br /> REGISTERED Y/ N FEE CURREA Y/N <br /> Address <br /> License# � <br /> MECHANICAL� � �- � <br /> SIGNATURE , (jt.�jj'}LQ �J COMPANY Af�/Q$ �J <br /> REGISTERED y/ N P ��� � "��� <br /> / E CURRE� Y/N <br /> Address t'-�'�-�-� [ �/J ,�— !/l ,3��j7' License# �.(� �`�J 9'[-d—� <br /> OTHER <br /> SIGNATURE COMPANY <br /> REGISTERED Y/ N FEE CURRE� Y/N <br /> Addross <br /> License# � <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Fortns;R-O-W Permit for new construction, <br /> Minimum ten(10)working days aRer submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilitles&1 dumpster,Slte 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)working days after submittal date. Required onsite,Conshuction Plans,StoRnwater Plans w/Silt Fence installed, <br /> Sanitary Facilities&1 dumpster.Site Work Permft for all new proJects.All commerciai requirements must meet compliance <br /> SIGN PERMIT Attach(2)sets of Engineered Plans. <br /> """PROPERTY SURVEY requtred for all NEW constructlon. <br /> Directions: <br /> Fill out application completely. <br /> Owner 8 Contractor sign back of applicatlon,notarized <br /> -. If over t2500,a Notice of Commencement fa requi►ed. (A/C upgrades over 57500) <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 Appllcatlon Only) <br /> Reroois if shingies Sewers Service Upgrades A/C Fences(PIoVSurvey/Footage) <br /> Driveways-Not over Counter if on public roadways..needs ROW <br />