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813aeo-oo2o City of Zephyrhills Permit Application Fax 813-780-ooz�
<br /> . _ ` s Bailding Department
<br /> Date Recefvad Phane:Cantac#for Parmitt(n ���� d a� - ���„J
<br /> t}wner'�Name ��'Il1�i �/`�U/ , Owner Pho�e Number 111�"' ��0-p�rFo+��
<br /> Owne�'s Address �!6 /4' (� � Owner Phone Number �- �
<br /> Fee Simple Tikleholder Name Owner Rhane Number' �� �
<br /> Fee Simple Titleholder Address
<br /> JOB ApDRE$S . 1� ///�70�-jL� �� LOT# ��
<br /> �
<br /> sueawisiaN f�/+N� 1.�7e/ZU PARCEL ID# �� �� �l f..�/�Gf l�� a��'��
<br /> I (OBTIOINED FROM PROP@RTY TAX NOTICE)
<br /> WORK PROPOSED , e NEW CANSTR�ADD/ALT Q StGN Q [� DEMOLISH
<br /> INSTALL. REPAIR I
<br /> Pi20POSED�USE [� SFR [� 'GONIM � Q� QTHER
<br /> TYPE OF C4NSTRUGTION � [�' BLOCK "'�Q FRAME �] STEEI. [�,
<br /> pE3CRIPTIdN OF WORK �9L� �Jo2 �bN -���'K/,g" G 'T L�!'!'7 CfJ'7�"7. /Vu�+
<br /> �
<br /> BUiLDING S1ZE �� � SQ FOOTAGE�.��. HEIGHT �___-�,_�
<br /> i
<br /> . , VALUATION OF TOTAL CONSTRUCTION
<br /> QBUt�DiA1G �� �
<br /> QEI.ECTRiCAI � � AMP SERViCE Q PROGRESS ENERGY [� W.R.E.C.
<br /> QPI.UMBINCa $ �
<br /> , � � S (,, �'
<br /> OMECHANtGA� $ .,_. VALUATI4N C}F MECHANICRL IhlSTAI.LATIQN � L�
<br /> � � 5. A��
<br /> QGAS � ROQFING .-[� SPECIAt:TY Q 03HER•
<br /> FINISHED FLOOR ELEVATIQNS ��� FI.00D ZONE AREA QYES NO
<br /> BUIE.DER CQMPANY
<br /> SIGNATURE REGISTERED Y/ N FeE cu�n Y/.N
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<br /> Address ' License# � �� �
<br /> ELECTRICIAN COMPANY
<br /> SIGNATURE � REGISTERED Y/ N �e euw�en -�Y/N
<br /> Xddress . Licanse# I I
<br /> P�UMBEtt � COMP_AMt f
<br /> SIGNATURE REGISTERED Y/ N FEE CURREA Y/N
<br /> Addr�ss LiCe�se# � �
<br /> ..
<br /> MEC1fANICAL. ` �� )��� COMP� �17�"NP� S ��jP�-1�I� �j-5�"��..• �
<br /> SIGNATURE �� l' � L REGISTERED Y/ N " FEE CURREA Y/N
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<br /> Address '���'� �`�f�111� �.�,.�pC .�- ltLS �35 f License# I ��`i`���.��l"��
<br /> OTH�R � CaMP�
<br /> SIGNATURE' � REGISTERED Y/ N _ Fee cuR�� Y/N.
<br /> i , .
<br /> Addreas � ` License# � �
<br /> RESEDENTIAL Attach(2}PIot.Plans;.(2}sets�of:Biilldliig�F'lans;={1}set of�Ener�yi�Forms;R-0-W Permtt for new construction,
<br /> Minimum;ten_(1.0);working;days.afkec_subriilttal date...Requlred onsite;Construcdon Rlans;StormwaterPlans w/Silt Fence installed,
<br /> Sanifary Facilitles;&1�,dumpster Site Wor1t�.Permit.for subdivis(onsllarge projects�
<br /> COMNfERCiAL Attach(3}caatplete sets of Suililing Ptan's plus a;�,ife Safety Page;{1}se#af Enet�gy Forms.R-Q VY Pemtit for new constsuct�ori,�
<br /> Minimum ten(10)working days after sutimittal dafe. �Required onsite,Canstructlon Plans,Stormwater Plans w/Silt Fence installed,
<br /> SaNtary Faciltdes&1 dumpster:Site Wark�Permit"for all►ieY�proJects.All commercial requtrements must meet compllance
<br /> SIGN PERMIT AttacFi(g)..sets af Engirteeted Plans...;� -�-_ . �} r - .
<br /> wr�rMPROPERTY SURVEY required for all NEW consWCtion.
<br /> Dlrectians: � ,
<br /> �fll out eppiicaHon completely.
<br /> Owner&Contraatar sign back af appllca�an,notarized
<br /> If over!�'500,a Notice of Comrnencement is required. (NG upgrades var 57500)
<br /> '• Agent(for tFie cantractor)or Power of Attoriiey(for the•ow�er)would be someone with notarized letter from owner autho�izing same
<br /> DYERTFtECOUNTER�PERMIITING""'""�"(�ron'�ofAP.Plica#iomOi►ly)',., r, �,� -
<br /> Reroofs if shingles Sewers Ser.vice Upgiades NC -,Fences(PIoUSurvey/Foatage)
<br /> ,.�,, ,. , ., ,��.
<br /> Drivewaya-Not over Counter if ori pi�blic�ioadways..need's ROV1lf.,' " �
<br /> ,,, s. ,, � ,.;:..� ..u„u:<..�H;.^,�, m
<br /> , _.._..a...�....�—,-.,......
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