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813-�ao•oo2o City of Zephyrhills Pe jmit Applicatian Fax-813-780-0021 <br /> 8uilding bepa�ent <br /> Date Recuived phone Contact for Perinittln ° - °�� -��-- <br /> ' �m � I . -�, ,. , , , , } <br /> Owner's Name ��rr�- Qwner Phona Num6er' <br /> 1 . . <br /> .,� . <br /> Owoer's Address � �`1"'Owrie�'Ph'cfnA�ldumber�y: � ,•� � <br /> I <br /> Fse Slmpl�Titlehoider Name � pwn�r Rhone Number <br /> i <br /> Fse Simpie Tltlehoider;Address � <br /> JOB ADDRESS � � � � V'�. � LOT# �_� <br /> - � <br /> I <br /> 3tJ8D#VIS101+i �` � '� PARCEL tD# I <br /> I (097AINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPQSED NEW CONSTR ADDIRLT � SlGN Q � DEMO�ISH <br /> INS7ALL 8 REPAIR I <br /> PROPOSED USE Q SFR � GOMM Q OTHER <br /> 7YPE OF CON3TRUCTION • Q BLQCK � FRAME � STEEL Q <br /> i <br /> D�3CRiPY10�d OF WORK � "��{' �c. � <br /> BUI�DING S1ZE SQ Ft)dTACaE � HEIGHT C�� <br /> �BUILQlNG � VALUATION OF TdTAL COFISTRUCTIQN <br /> , /��� <br /> �ELEC1'RIGAL $ ��� � AMP SERVICE ,�v Q 'PRQa�SS sNE�c�Y [� w.�.E.c. <br /> QPLUMBING ��� <br /> QMECHANICAL $ VALUATlON OF MECHAIVICAI.INSTALLATION /���"(- <br /> � � <br /> QGAS Q ROOFING Q SPECIALTY � OTHER <br /> FIIVISHEd FLOOR ELEVATIONS � � FLOOD ZONE ARE'I QYES NQ <br /> „_,,,,_„ � <br /> � <br /> BUiLDER COMRANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y I N <br /> Address �Icense# <br /> B�EGTRICIAN COMPANY � l � "C C !� � <br /> SIGNATURE " Re�isrEREO N �E cuRREn Y!N <br /> Address 1 �Ic�nse# ��. �, (�?c�a �2{p�1 <br /> P�UMBER COMPANY I <br /> SIGFlATUF2E REGISTERED Y/ N FEE CURRE� Y I N <br /> Addre�s �icense# � � <br /> ,,,.. .,_,_, <br /> MECHANIG1e1!_ CQMP/1PlY I <br /> 81GNATURE REGISTERED Y! H PEE CtlRRE� Y 1 N <br /> Addrs�s License# C � <br /> 07HER M. 1_Y. � COMPANY I <br /> StCaNATU}tE ,,.. RE�1STEftED Y/ N FEE CURREh Y/hl. <br /> Addres� license# �- � <br /> RESIDEIdTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)seEof Energy�Fonns;R-O-W Permltfor new canstruction, <br /> Mlnlmum.ten{10)warking.days after.submittai date. Requitei!ansite;Construction Plans;Stormwater Plans w!Slit Fence installed, <br /> Sanitary FacillUes&1 dumpster,Site WorlrRermit for subdivislons/large projects, <br /> COMMHItC1AL Attach(3)�complete sets of 8uflding Pians plus a Ufe Safety Page;(1)set of Energy Forms.R O-W Permit for new construotlon. <br /> Minimum tan{14}warking days after submlttal date: Required onsite,Gonstructton Pians,Stormvtrater Pians w!Silt Fe�cs 3nsta1led, <br /> Sanitary Facilities&1 dumpster.Site Work Permit for all new projects.All cnmmercial requlrements must meet compllance <br /> SlGN PERMlT Attach(2)sets ot Engineered Plans._ j <br /> ""PROPERTY SURVEY requlred for alt NEW consfruct(on. � <br /> Directlons: ( <br /> F18 out appllca�an campletely. I <br /> Owner&Contractor sign back of appllcaUon,notarized <br /> If aver 52500,a Not4ae of Gommenceme»t la required. (AIC upgrade�over�7544j <br /> '" Agent(for the conhactor)ar Power of Attomey(for the owner)would be sameone with nota�ized lekter from owner authorizing same <br /> DYER TliE COUNTER P6RMiT1'ING {Front of Applicaflon Oniy) <br /> Reraafs if shingtes Sewers Service Upgrades A/C Fanaes(PlatlSurvey/Footage} <br /> Drtvewaya-Not over Counter if on publlc roadwrays..needs ROW <br /> ! <br /> I <br /> � <br />