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<br /> 813-780-0020 City of Zephyrhills Permit Application Fax 813-780-0021
<br /> Buflding Department
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<br /> Date Received _ ,_ -- ..,__,,, --.- - G� 3 ,.7,�/.2. _.., �Q��
<br /> � • ,Phone Contact for Permittln� .'D�' �s -
<br /> }, q :�: . 4 .... .. ...: ... ..:..:... . _��� ` 781�-2Z�
<br /> Owne�'s Name .`'/"���.����" `.-�"�D�N t� Owner'PHone Num�ier �?- �'
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<br /> Owner's Addrgss-.�� ,%� .�U�— � '4�;Oviiner Pfione Number __
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<br /> Fee 1Slmple Titlefiolder Name,+ �' :' Owner Phone Number
<br /> Fee Simple Titleholder Address
<br /> JOB ADDRESS '�f6�� / - <�� �y�- LOY# �
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<br /> SUBDIVISION L?�/'}�� �r���� PARCEL ID# 3� 3� v�1 G`�� ��d0� ����
<br /> I (OBTAINED FROM PROPERTY TAX NOTICE) -
<br /> WORK PROPOSED NEW CONSTR ADD/ALT Q SIGN Q Q DEMOLISH
<br /> B INSTALL REPAIR I
<br /> PROPOSED USE Q SFR [�, COMM Q OTHER
<br /> TYPE OF CONSTRUCTION Q. BLOCK Q FRAME � STEEL Q �
<br /> DESCRIPTION OF WORK _. /`"�=��y� .`� �E �Qe e-� � �p� j�K /�71C �� p��/U�
<br /> BUILDIPIG SI2E � SQ FOOTAGE� HEIGHT -
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<br /> QBUILDING � � $ VALUATION OF TOTAL CONSTRUCTION •
<br /> QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY' Q W.R.E.C.
<br /> QPWMBING $ �
<br /> QMECHANICAL $ �C�QY Q� VALUATION.OF MECHANICAL INSTALLATION
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<br /> QGAS Q _ROOFING Q SPECIALTY Q OTHER
<br /> FINISHED FLOOR ELEVATIONS , FLOOD ZONE AREA QYES NO
<br /> BUILDER COMPANY
<br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
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<br /> Address I - License#
<br /> ELECTRICIAN - COMP i Y `
<br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
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<br /> Address � I License#
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<br /> PLUMBER COMPANY
<br /> SIGN.ATURE REGISTE�ED Y/ N FEE CURRE� Y/N
<br /> Address � " I License,#
<br /> MECHANICAL Gz�� � COMP.� ��2 S ,�o/�A-N�G�S�����c
<br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
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<br /> ; Address - I License# ����3��d
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<br /> OTHER COMPANY
<br /> SIGNATURE REGISTERED Y/ N _ FEE CURRE� Y/N.
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<br /> Addre�s - � I � � � � Llcense#
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<br /> RESIDENTIAL Attach(2)Plof Plans;(2)sets=of�Building'Plans;(1)set of En1ergy�Forms;,R-O-W Permit fornew construction,
<br /> Minimum:tem(10),working,days-after.submittal date. Required onsite,ConsUucBon Plans,Stormwater Plans w/Silt Fence installed,
<br /> � Sanitary FaciliUes�&t dumpster Site Wor1c Permitfor subdivislonsAarge projects
<br /> COMMERCIAL Attach(3)complete sets of Bulldirig Plans plus a:Ltfe Safety�Page;(1)set of Energy Forms.R-O-W Permit for new construction.
<br /> Minimum ten(10)working'days after submittal date. Required onsite,Constructlon Plans,Stormwater Plans w/Silt Fence installed,
<br /> Sanitary FaciliUes 8 1 dumpster.Site Work Pertnit for all ne�projects.All commercial requlrements must meet dompliance
<br /> 51GN PERMIT Attach(2)sets of Erigineered Flans:,, .
<br /> ""PROPERTY SURVEY required for all NEW construcUon.�
<br /> Directlons:
<br /> Fill out applicatlon completely:
<br /> Owner&Contractor sign back of applicadon,notarized . �
<br /> If over 52500,a Nottce of Commencement is requlred. (AIC upgrades,over 57500) ' �
<br /> " Ptiqent(for the contractor)or Power of Attomay(for the owner)would be so�eone with notariiei!letter from owner authorizing same
<br /> OVER THE,COUNTER PERMITTING (Front of Application•Only)
<br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage) , -
<br /> Drlveways-Not over Counter if on public roadways..needs ROW
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