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613-780-q020 City of 2ephyfiills Permit Applicatian Fax 813-780-0021
<br /> ` 8uifding Department
<br /> � ; �t� _ �2� - 3 Sg �
<br /> Date fi'eceived l � ""2 �
<br /> '��,� Phone,Gontac#far Per'mtttin
<br /> Owner's Name e C,,. t� l� � , l Owner Phone Number
<br /> Owner's Address �C�[ � l'r�'��✓'"� � f � i dwner Phone Number -•
<br /> Fee Slmpla Tltleholder.Name Qwner Rhone Number
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<br /> Fee Slmple Tltlehalder Address
<br /> JOB ADDRESS S�'^'� Cj { �'j C h� 1 f�,3,� ��,�,QT# C�
<br /> SUBDIViStON �� � PARCEL tD#
<br /> ! (09TAINED FROM PROPERTY 7AX NOTICE)
<br /> WORK PROPOSEp NEW CONSTR ADD/ALT , � • S1GN Q Q DEMOLiSN
<br /> INSTALL. 8' REPAIR
<br /> PROPQSED_USE Q SFR [� 'COMM Q OTNEft
<br /> TYRE OF CON3TRUCTION � Q' BLOCK ''}Q FRAME � STEEL Q
<br /> DESCRIPTION OF WORK �""1�%►'7�� ��I� ��. '�� ,� .� ��'^�""`�
<br /> BUtLD1NG SIZE �� ' � SQ FCIOTAGE HEIGHT �
<br /> - , -
<br /> [�BUILDING �� I ,
<br /> VAt.UATIt3N OF TOTAL CONSTRUCTION
<br /> QELECTRlCAL $ . AMP SERtttCE � Q Pt20GRESS ENEf2GY � W.R.E.C.
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<br /> QPLUMBING �& � . .
<br /> MEGNANIGAt. $ ' � VALUATION OF MEGHANIGAL INSTRLI,ATtQN
<br /> � � �
<br /> QGAS Q ROQFING.. Q SPECtALTY Q OTHER
<br /> FINISHED FLOOR ELEVATIONS �� FLOdD ZON�AREA QYES NO
<br /> BUIl.DER � ��.~ CQMP� 1 l l t ! '�T ���G`�Y�C
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<br /> SIGNATURE � REGISTEREp Y/ N Fes cu Y/N
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<br /> Address � 3�� �L�% � .�L.�,' .i kicense`#�I ' �
<br /> EI.ECTRlClt�tid Ct�MP�
<br /> SIGNATURE T� REGISTERED Y/ N FEE CURRE� '-Y/-N
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<br /> Address � License# � �
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<br /> P�UMBER COMP.�
<br /> SIGNATUR� �REGISTEREp Y/ N FEE CURRE� Y/N
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<br /> Address � I.icense# � ��
<br /> MECHANICAL GOMP,�
<br /> SICiNATURE REGISTERED Y/ N FEE CURRE� Y/N
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<br /> Address � � � " License# � �
<br /> OTHER GOMPANY
<br /> S1GAIATURE� ' � REGISTERED Y/ N FEB CURRE� Y/N.
<br /> - ---- Addt6f38 - - -y - -' J� 1.IC8RS8# � �
<br /> REBtDENT1AL Attarfi(2}.P1ot:P#ans;.(2}set&:of:'Biiildiiig`Plans;°{�1)set of�Enetgy�Forms;R-t3-W Petmtt for new cans#ruc�on,
<br /> Mtnimum;.ten;_(:1.Q).war{cing,days:after"sudrriitta)date:.Required:onsite;Consduction Rlans;Stormwater'Rlans w/Slit Fence installed,
<br /> 'SaNtary�Facilitlas:8�:1;,dumpster�•SlteWoric�.Penn(tforsubdiVislons/large�projects� '
<br /> COMMERCiAL Attach(3}cait�plate sets of 8u1liiing Plans plus a life Safe#y Page;(1}set of Energy Forms.R-0 W Permit for new.eanstruction.
<br /> Minimum ten(10)working days'after submlttal date. Requ(red onsRe,Construction Plans,Stortnwater Plans w/Silt Fence installed,
<br /> Sanitary FaciltUes 81 dumpster.Site Work Permit for all new projects.All commercial requlrements must meet compllance
<br /> SIGN PERMIT Attach{2)sets of Engltieered�Pians;,:: �-�: ~ „ , � .
<br /> ""'PROPERYY SURVEY requfred for all NEW construcUon.l
<br /> Dlrecttana: ' . _`i ,
<br /> Fill out applfcaHon completely.
<br /> Owner&Coohactor s{gn back of appllcatlon,notarized
<br /> if aver�2500.a Natice of Cammencement i�required. {AtC upgrades ovar 57500) _ D -
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<br /> '• qqent(for ttie contractor)'or Power of"Attomey(for the owner)would be someone with notarized letter from owner authorizing same
<br /> OVER THE COUNTER PERMITTING (Front of A�pllcation•Only} � °, � : �-_; .,. =
<br /> Reroofs if shingles Sewers ,- Service Upgrades' NC�-". -Fences(PIotlSurvey/Footage) , . . , " ';' .
<br /> Drlvewaya-Not over Counter if on public�"r�oadduays::riseds RG3W;, • y � ~ . '` L, , .`� , �
<br /> ; , . ;r . r: - . � � , . ... __ ..� K ..
<br /> 5.;.,__s, n �,�._. z,!�+o->r •..-. arvw t.x.-.. .. -....,�.. �
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