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<br /> °��-,��w��� c:ity ot�ephyrhills Permit Application Fax-813-780-0021 �
<br /> Buflding Department
<br />� .te Recelved �� q � ,j ��2 ��G� — �
<br /> Phone Contact for Permitting CJ O
<br /> rner•s Name �S � � Q/i) Owner Phone Mumber
<br /> rner's Address ( � j� �� (� � Owrner Phone Number
<br /> e Simple Tltleholder Name Owner Phone Number
<br /> e Slmple Titleholder Address
<br /> �B ADDRESS � � � V /"!�/9 ��i(��Q' DO � LOT# �
<br /> IgDIVISION PARCEL ID#
<br /> (OBTAINED FROM PROPERTY TAX NOTICE) '
<br /> )RK PROPOSED � NEW CONSTR B ADD/ALT 0 SIGN � � DEMOLISH
<br /> INSTALL REPAIR
<br /> :OPOSED USE �� SFR Q COMM � OTHER
<br /> PE OF CONSTRUCTION [� BLOCK Q FRAME [� STEEL Q ,
<br /> ;3CRIPTION OF WORK �0 �C p�� !�� 6 '�
<br /> IILDING SIZE SQ FOOTAGE� HEIGHT
<br /> UILDING $ ��`�` � VALUATION OF TOTAL CONSTRUCTION
<br /> /
<br /> ELECTRICAL $ AMP SERVICE Q PROGRESS,ENERGY �] W.R.E.C. I
<br /> OPLUMBING $
<br /> QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION r `� ��
<br /> �
<br /> QGAS Q ROOFING Q SPECIALTY � OTHER
<br /> IISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES MO
<br /> ILDER _ l��I��' � c//'�// `5,0'_1 "cCOM ANY �w►l Lf"�
<br /> iNATURE `-� `�v REGISTERED Y/ M FEE CURRE�
<br /> Y/N
<br /> Address
<br /> � License#
<br /> ECTRICIAN � COMPANY
<br /> 1NATURE
<br /> REGISTERED Y/ N FEE CURRE� Y/N
<br /> Addrass ' �
<br /> License#
<br /> 1MBER COMPANY
<br /> �NATURE
<br /> REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address
<br /> License# -
<br /> CHANICAL COMPANY
<br /> NATURE REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address
<br /> License#
<br /> �ER COMPANY '
<br /> NATURE REGISTERED Y/ N FEE CURRE� Y/N
<br /> Addres�
<br /> License#_ �
<br /> iIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit far new construction, ^,S
<br /> Min(mum ten(10)working days aRer submittal date. Required onsite,Constructton Plans,Stormwater Plans w/Silt Fence installed, �'
<br /> Sanitary FacllfUes&1 dumpster;Site Work Permft for subdivisionsAarge projects
<br /> AMERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Fortns.R-O-W Permit for new conshucHon.
<br /> Minimum ten(10)working days�after submtttal date. Required onsite,Constru�tion Plans,Stormwater Plans w/Silt Fence installed,
<br /> Santtary Facilities&1 dumpster.Site Work Permit for all new projects.All commercial requirements.must meet compliance
<br /> N PERMIT Attach(2)sets of Engineered Plans.
<br /> ""PROPERTY SURVEY required for all NEW construction.
<br /> ctlons:
<br /> FIII out applicatlon completely.
<br /> Owner 8 Contractor sign back of appifcation,notarized
<br /> If over�2500,a Notice of Commencement Is requlrad. (AIC upgradas over�7500)
<br /> Agent(for the contractor)'or Power of Attomey(for the owner)would be someone with notarized letter from owner autho�lzing�sam���^°�•°==��.=;�x,�u:J°�
<br /> :R THE COUMTER PERMITTING (Front of Appifc2tion On"ly)�";`",.�."�. ,%�`-��`:`j� ' ��,:._. ;,�!� :�(' ,. ;
<br /> hingles Sewers Service U rades '� �� � ' '� ,> " -�� � - •�
<br /> �ofs if s pg q/C� �Fence`s(PIoUSuniey/Footage) � �'� ; � `' •� �- =ti
<br /> Driveara .;:;;.,._� � ,,,�':;,;r,.•,, ., '�,,. �y ,,e,�� , ,,�•:,:._ :,..,. ..:r,--. , " •
<br /> ys-Not over Counter tf on publicl�►oadwaqs: _°�� - � ^,-'� '' `".'�" - ` " j-- 4 U...,. , .-. �l
<br /> �.needs ROW' ''
<br /> + �.=Y•�• . ... �.�+ -t b�+ _•RR:-.v . .—4?�t� vu t�va t�i�r
<br /> ,.• vrc.anr'Mraw.<.._f�t�'PL�T n�4':9T.a'tl^l:'tn,�t.1:.+•.
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