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s�3-�ao-oo2o City of Zephyrhills Permit Application Fax-813-780.0021
<br /> ., . .x ,_4 , Buliding Depatiment .
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<br /> D�te Recsiv@CI . �,,".;;',' ;�'ti!�t:° i:1 sc ;�r �, � `.. �,Q ,,,,:.. .
<br /> .�R.• •-,.•:,:� �^�� n Phone-CantactforPermittFn ; .�5���`�,,�'':: •?�7,3; -,,,�',�`�i �7��'7
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<br /> Owner's Name���,�:: ".� Oxiner-�tior'ie Aluin6er i+ '.'
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<br /> Owner's Address �' ,,,J """�- .�;��`Owner Phone Nu�nper-•+� ��
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<br /> Fee 8lmple 7�Itleholder Name ! Owner Phane'Number
<br /> Fee Simple Titleholder Address �
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<br /> JOB ADDRESS LOT#
<br /> SUBDIViSION • �� � PARCEL ID#
<br /> (OBTAINED FROM PROPERTY TAX NOTICE)
<br /> WORK PROPOSED NEw CONSTR ADDIALT � StGM1t Q Q DEMQI.ISH
<br /> � , e INSTALL 8 REPAIR
<br /> PROPOSED USE r � SFR Q CQMM �� OTHER
<br /> TYPE OF CONSTRUCTION C] BLOCK Q FRAME EEI. Q �
<br /> DESCRIPTION OF WORK
<br />' BUtLDING SI2E � � SQ F 7AGE��� HEIGHT ���
<br /> I� �$�«����'' � VALUATION OF T07AL CONSTRUCTiON
<br /> QEI.ECTRICAI $ AMP SERVICE � PROGRESS ENERGY Q W.R.E.C.
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<br /> QPLUNtBiNG $ -�-�;:� t-'���
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<br /> OMECHANtCAI. V UATIQN QF MECHANICA�INSTA�lAT10N
<br /> I QGAS Q ROQFING Q SPECIA�TY C� OTHER
<br /> � FINISHED FLOOR ELEVATIO FLOOD ZONE AREA QYES NO
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<br /> i BUI�DER C{}MPANY
<br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
<br /> �I Address License# �� �
<br /> E�ECTRtClAN COMPANY
<br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address Ucanse# � �
<br /> ' P�UtVIBER COMPANY
<br /> SIGNATURE REGISTEREp Y/ N FEE CURRE� Y/N
<br /> Address License# � �
<br /> MECHANICAI. CCIMPANY
<br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
<br /> � Address � Li nse#
<br /> ' OTIiER COMFANY
<br /> SIGNATURE REGISTERED / FEE CURRE� � Y/N -
<br /> Address ✓ License# ���Z._..----�
<br /> RESIDENTIAL Attach{2)Pla#Flans;.{2}sets�of"Bulldl Plans;(1}set of Energy�Farm's;R-O-W RermiE for aew canshvction,
<br /> Minimum,ten,(�10);working;days_after.submittal date: Required onsite,Construc�on Plans,Stormwater Plans w/Sflt Fence instailed,
<br /> Sanitary Fadlities.&-1.dumpsker_Slte Work P.ermit for su6divisionsAarge proJects
<br /> COMMERCIAL Attach{3}complete seGs of Buittlirig Plans plus a L{fe Safety Page;{1}set of Energy Fotms.R-O-W Petmit#or new canstcu�tion.
<br /> Minimum ten(10)wo�lcing days afker submittal date. Required onsite,Canstruction Plans,Stormwater Plans w/Silt Fence installed,
<br /> Sanitary FeclliUes d�1 durnpstar.Site Work Permtt tor all new proJects:Atl commercial�equtrements must meet c�mpHanca
<br /> SIGN PERMFT Attach{2)sets af Engineered Plans.
<br /> "`"'PROPERTY SURVEY required for all NEW construodan.
<br /> Dlractions:
<br /> Fill out applicaUon completely.
<br /> Owner&Contractor sign back of appf(caUon,nofa�ized
<br /> tf over 52500,a Notice of Comrnencement is reguired. {A!C upgrades over bT500)
<br /> " Agent(for the conVactor)or Power of Attomey(for the owner)would be someane with notarized letter from owner authorizi�g same
<br /> DVER TFtE COUN'iER PERMITTING (Front of AppNcation Only}
<br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Foatage)
<br /> Driveways-Not over Counter if an public roadways..needs ROW
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