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o�,rrau-vu�v Gity af 2ephyrhills Permit Application FaX s�s-7saoo2� <br /> .. Buitding department <br /> Date Rsaaiv8d Phane Contact for Permitttng — <br /> Own�r's Name I� �L�'�J�/�' Owner Phane Numbe <br /> Owner's Addres� IQ�c�"+� "5���� ���S Owner Phone Number <br /> Fee Simpte Titieholder Name � ��w i� Q+++rner Phone Number <br /> Fee Simple Titlehotder Address <br /> JOB AbDRESS ��-�3 �l y!/'�2' Q�}/1,� LOT# [�� <br /> susn�visioN ���L11�/L 0�.5� P�c��ro# a 3�-�-a2�-- Oj,��'00�d�-- ,�l<S� <br /> (09TAINED FROM PROPERTY TAX NOTiCE} <br /> WORK PROPOSED e NEW CONSTR 8 RDD/ALT [� SIGN [� Q DEMOLtSN <br /> INSTALL f2EPAtFt <br /> PROPOSEp USE Q SFR Q COMM C� QTHER <br /> TYPE OF CONSTRUCTtON Q BLOCK [� FRAME C� STEEL Q <br /> DESCRIPTION OF WORK ,�c-��'`"� �✓2 `�'1'�'f� �G�� �a /L''�'/�/!�� <br /> BUiLDING SIZE �—� �Q FOOTAGE Q HEIGH7 ��____� <br /> QBUILDlNG $ �� `� VALUATION OF TOTAL CONSTRUC710N <br /> � <br /> �]ELECTRIGAL I $ AMP SERVICE Q PRqGF2ESS ENERGY Q W.R.E.C. <br /> QPLUMBING �� � <br /> [�MECHANICAL $ VALUATION OF MECHANICAL INSTAI.LATlON ��� <br /> �� . <br /> �GAS �� ROOFING Q SPECIALTY � OTHEFt <br /> =tM1lfSHED FLOOR E[.EVATtONS �T� FLOOD ZONE AREA QYES NO <br /> �� i <br /> 3UlLDER CONIPANY <br /> 31GNATURE REGIBTERED Y/ N FEE CURRE� Y/N <br /> Address � Ltcense# � � <br /> :LEGTRICIAN COMPANY <br /> itGNATURE REGiSTERED Y/ N �e cuaR�n Y/N <br /> Address Ucense# �_r —i__� <br /> �WMBER � � COMPANY <br /> iIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Acldress License# �_ `� � <br /> �ECHANICAL GOMPANY <br /> il(3NATURE REGfBTERED Y i N FEE CURRE� Y 1 N <br /> Address License# � "� <br /> 1THER ���.// �� w� COMPANY U`�`d��i� ��''� <br /> �IGNATURE �r G RE,�SIS'fEF2Eb Y i iU FEE CURRE� Y J N <br /> Address �l� ���- Z��,3 ��u�"' L°l� � License# ���7�.�-`t� � <br /> ;EStDENTIAL Affach(2)Plat P�ans;(2)sets of Building Plans;(1)set of Energy Fort»s;R-O-W Perinit for�ew construction, <br /> Minimum ten(10}working days after submtttal date. Requlred onsite,ConstruoHon Plans,Stormwater Plans wJ Sqt Fence instaited, �_ <br /> S_anitary Facilitiss.&1._dumpster;Sike Work•F!ermit Eor subdivistonsllarge proJects �� -� � <br /> OMMERCIAL Attttach(3)complete sets of Building Plans plus a l.ife Safety Page;(1)set of Energy Forms.R»O-W Pettnit Eor new c:onstruc8on. <br /> Minimum ten{1 Q)wo�icing days after submittal date. RequSred o�slte.Constructian Plans,Stormwatet Plans wi Sift Fence installed, <br /> Sanftary Facilities&1 dumpster.Site Work Permit for all new proJects.At!cammercia!requfrements must meet comp8ance <br /> IGN PERMIT Attach{2)sets of Enginesred Plans. <br /> """PROPERTY SURVEY requlred for al!NEW conshuGtion. <br /> � Irections: _ <br /> Fill aut appl(cation s�omplstely. j\ ` , - <br /> Owner&Ccntractor sign back of appllcation,noE��ized , � ��` �. ' , }. � <br /> If over 52500,a Notice af Commencement is required. (A/C upgrad�s ovar�5��500j , ;� ,��., <br /> Agent(for the contractor)or Power of Attomey(for the owner)wauld b'e someone v;n'th notarized letter from owner authorizing same , <br /> , VER THE COUNTER PERMITI"ING (Front of Application Onty}, -> • <br /> eroots IF shingles Sewers Service iJpgrades A/C Fences(Piot/SurveylFootage} � ` ;� <br /> Drlveways-Nak over Counter if an publia raatiways..neecis R01N ,µ � � , ` <br /> , , , . . v r' <br /> , � 7 ,.,.. , ,� ., _.. . .,_.>. �_ _ :.,. , , � <br />