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�- <br /> o,�-��u-w�u c;ity ot[ephyrhills Permit Application Fax-813-780-0021 <br /> Building Department <br /> Date Rec�ie�d Phone Contact tor Pertnittin - <br /> . � <br /> I� Ovener's Idame / � � ..��md� Owner Phone Number �3 ���U�� <br /> �tnrner's Address � �� �ul�� �� � ��O��vner Phone tdumber �l�'� < ` ������ <br /> Eee Simple Titleholder ldame � Oamer Phone Mumber <br /> Fee Simple Tttleholder� T!ou�Al:t�tN d' +-�A ¢' ,�Hrl/ ' L_ <br /> .�oB e►o�R�ss � C�/� �7 t1L— l� y��� / ��`�� LOT# � <br /> SUBDIHISIOM PARCEL ID# / ��E�"���'O���'�C'��a6 �C7C'�� <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> W06tEC PROPOSED B NEW CoNSTR� ADDlALT Q SIGN Q Q DEMOLISH <br /> INSTALL REPAIR <br /> �ROPOSED USE Q SFR � COMM Q OTHER � <br /> �YPE OF COWSTRUCTIOM Q BLOCK Q FRAME Q STEEL Q <br /> pESC(tIPTIOId OF MHORK ' ° � �-�1 ��/�T�i'9��� ��/ <br /> �UILDIMG SIZE SQ FOOTAGE� HEIGHT <br /> QBUILDING $ VALUATION OF TOTAL CONSTRUCTION <br /> QELECTRICAL $ AMP SERVICE 0 ' . PROGRESS ENERGY Q W.R.E.C. <br /> OPLUMBING $ <br /> �MECHANICAL $ ,�j� VALUATION OF MECHANICAL INSTALLATION <br /> '1 . <br /> QGAS Q ROOFING Q SPECIALTY � OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO <br /> �UILDER - � COMPAMY <br /> SIGIdATURE � REGISTERED Y�I IV FEE CURRE� Y I M <br /> Address License# <br /> ELECTRICIA(d COMPAMY <br /> SIGMATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> PLUIMBER COMPANY <br /> SIGIdATURE REGISTERED Y/ N FEE CURREA Y/N <br /> 4lddress Ltcense# <br /> MECliAfdICAL � COMPANY d��l S� ���u� ��/7��ir��-- <br /> �IGfNATURE � u' REGISTERED Y/ N FEE CURRE� Y/N <br /> Address l�� �A �� �o>--�� � �� '2� License# t.-/�( �J�d� � <br /> OTHER COMPANY <br /> SIGMATURE REGISTERED Y/ IV FEE CURRE� Y/N <br /> Address License# <br /> RESIDEIdTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(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 8�1 dumpster,Site Work Permit for subdivislonsAarge projects <br /> COAAI�EEtCIAL 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 submtttal date. Required onsite,Canstruction Pians,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities&1 dumpster.Site Work Permft for ail new projects.All commerc(al requirements must meet compi'iance <br /> SIG(d PERMIT Attach(2)sets of Engineered Plans. <br /> ••°•PROPERTY SURVEY required for all NEW consUuction. <br /> Directions: <br /> Fill out application completely. <br /> Owner&Contractor sign back of application,notarized <br /> If oeer 52500,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 sameone with notarized letter from owner authorizing same <br /> ONER THE COUNTER PERMITTING (Front of Application Oniy) <br /> Reroofs if shingles Sewers Servlce Upgrades A/C Fences(PIoUSurvey/Footage) <br /> Driveways-Not over Counter if on publlc roadways..needs ROW <br />� <br />