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813-780-002d City of 2ephyfiiil Permi#Appli+cation Fax-813-780-fl421 <br /> Building epartment <br /> Date Received ~ Phona Co�tact for Permittin � l3 �� � ` � � <br /> ;�Owner's Name ��� ����-�`-' Owner Phone Number � �3�� `���� `�� <br /> �Ow►ier's Address �3 � Owner Phone Number �� � <br /> Fee Slmple Titiehotder Name Owner Phone Number �� � <br /> Fee Simple Titiehaider Addness <br /> � � L___T�� <br /> �J08 ADDRESS �� `� � �OT# <br /> SUBDNt31C)N � � FARCE! <br /> (06TAINED FROM PROPERTY TAX NOTICE) <br /> YYORI{PROP4SEQ N£W CQNSTtt 8 ADOlA�T ��"' SIGN Q Q DEMOUSN <br /> tNSTALL REPAIR <br /> PROPOSED USE SFR � COMM �� OTHER <br /> TYPE OF CUNSTRUCTIQN Q BLOCK Q FRAME S7EEt Q <br /> ,�CDESCRIPTION OF 1N�RK <br /> BUILDING SIZE �� � SQ FQOTAGE HEFCaHT ��� <br /> QSUIlD1NG $3 �C� � VAL.UATION F TOTAL CONSTRUCTICitV <br /> �E4.ECTFtICAL �&� AMP SEf2VIC Q PROGRESS ElVERGY �] W.R,E.G. <br /> �PLUMBING $ ^'----� <br /> OMECHANIGA! � VAL.UATlON F MECHANfCAL{NSTAUATION � ��� � <br /> � <br /> QG S FING Q PECIAL � OTNER <br /> FINISHED FL OR EL A ONS F OOd Z NE AREA QYES NO <br /> � ��t '� <br /> BUtl.DER Ct) ANY <br /> IGNATURE REGI TERED Y/ N FEE CURRE� Y/N <br /> ress License# �� � <br /> ELECTRfC1AN CO PANY <br /> SIGNATURE REGI TERED Y/ N FEE CURRE� Y/N <br /> Address License# � �� <br /> PIUMBER � � CO PANY <br /> SIGNATURE REGI TERED Y/ N FEE CURRE� Y/N <br /> Addresa License# �— �� <br /> MECNANICAL Cd PANY <br /> SIGNATURE REGI TERED Y/ N FEE CURRE� Y/N <br /> Address �icense# � � <br /> QTHER CO PANY <br /> SICNATURE REGt TERED Y 1 N FEE CURRE� Y!N <br /> Address �icense# �- � <br /> RESIDENTIAL Attach(2}Piot Pians;{2�sets of Buiiding Pians;(1}set o Energy Forms;R-O-W Permit for new c�nstruction, <br /> Minimum ten(10)woriting days after submittai date. Re uired onsite,Construction Plans,Starmwater Plans w!Sil#Fence ins#atted, <br /> 5anitary Fadlities 81 dumpster;Site Work Permft for su divisionsAarge projects <br /> Ct>MMERCIAI Attact►{3}complete sets af Bufiding P1ans pius a life Sa ety Page;{1)set af Energy Farms.R-O-W Permit for new constructlon. <br /> Minimum ten(10)working days after submtttai date. R uUed onsite,Construction Pians,Stormwater Pia�s w/Silt Fence instaqed, <br /> Sanitary Facilities&1 dumpster.Site Work Permit far all new projects.All commerclal requirements must meet compliance <br /> SIGN PEitMlT Attach{2}sets of Englneered Ptans. <br /> ""PRQPERTY SURVEY required for all NEW construc ion. <br /> Directtans: <br /> Fill out application completely. <br /> Owner&Contractor sign back of application,notarized <br /> 1f over;2500,a Natice of Gommencemet�#Is requ3red. {A!C upgr es oYer STSaa� <br /> •" Agent(for the contractar)or Power of Attomey(for the owner)would b someone with notarized letter from owner authorizing same <br /> DYER TNE COUN'tER PERMt'fTING {Front of Application Only} <br /> Reroofs if shingles Sewers Service Upgrades A1C Fences IaUSurvey/Footage) <br /> Driveways-Not over CouMer if on pubfiic roadways..needs ROW , <br />