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813a�o-oo�o City af Zephyrhills Permit Application Fax 813-780.0021
<br /> Bulldtng Department �
<br /> �.- -e. .
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<br /> Date Recelved . . Phone Cantact�far PeTin[itin .� � _
<br /> Owner's Name Gt'�,. �b "cY'►£.�C' Owngr Phane Humber
<br /> Qwaer"s Address ���3 � �• �a 2 Owner Phone Number � �
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<br /> Fee Slmple 7ltleholder Name� � � � Owner Phone Number �� �
<br /> i:��' '��
<br /> Fee Slmple Tltleholder Addre�s '"
<br /> JOB ApDRESS ��"�,�J �� �� LOT# C�
<br /> suBawisioN � �� . PaRCE�.i� 1l- 2�O-2.l • CX�1� --O�r�� - ad'7 0
<br /> � - (OBTAfNED.FRCMPROP6RT1!7AXNOSICE)�
<br /> WORK PROPOSED '�NEW CONSTR' ' : ADD/AL1' �` SIGN' Q Q DEMO�ISH
<br /> . � INSTAL,.L � REPAIR �
<br /> PRORt}SED=U3E Q SFR � COMHJI` � OTHEF2 . .
<br /> TYPE OF CONSTRUGTION�": `[�] BLOCK '' 'Q FRi4ME � STEEI:: '[,�`
<br /> DESCRIPTIOMOF WpRK �°�" �v l� '�' �� "�"��
<br /> BUILpING SIZ� •�� � SQ FOQTAGE'��. , HEICiHT :�„��� �
<br /> QBOILDING � � .VAWATION�O�F'70TAL�CONSTRUCTION
<br /> �EIECTRICAL r>��� �� AMP SERVICE � PRQGitESS ENERGY Q W.R.E.C.
<br /> L �
<br /> �PLUMair�� . � --�
<br /> . C�.. �� :. �f���-�
<br /> [�MECliAN1CAL $ ' �VALUATION dF MECFiANICAC INSTALLA'TtON `
<br /> QGAS Q FtQQFII?tCa •Q SPECIALTY �. - .OTNER. _
<br /> FINISMED FLOOR ELEVATIQNS ��� FLOOD ZONE AREA QYES NO
<br /> BUILP�ER COMPANY ' �
<br /> SIGNATURE REGISTEREp Y/ N FEE CURRE� ` Y/N
<br /> Address - �� License# I �
<br /> ' � M�.�-; �.t��r- ` ��.,
<br /> ELECTRtC1AN. 7����'' �_ - CQIIIIPANY' � i'1 1 c�.
<br /> SIGNATURE a� RE(31STERED Y/ N FEE'CURREh �Y/N '
<br /> Address �•�1��'C'� �� �L. 3 � . . -Ucense#: ���3�� ���`J �
<br /> PUJMBER . . . ; CdMP<ANY� � � � '
<br /> SIGNAYURE "� ,REGI3TEREP Y./.:N FEe cuRttE�- Y/N _ � -
<br /> Address � Ucense#�� �
<br /> MECHANICAL � CQMPANY � +
<br /> SIGNATURE- ' ' " ` :.. i?EGisTeRea , , � Y./_,N FEE 6u�n Y/N,,.
<br /> Address � " .License# � �
<br /> O'fHER ' - . CdMPANY �� f . �
<br /> SIONATURE � " ' - � ' `REGISTERED Y/ N..=_ FEE,CURRE� Y/N . .
<br /> Addreasi - .�; _, .;.-� - •,'.�,;.-.,,,�,_::" - . ._ . License# � _ , . -
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<br /> RESiDENT{At:: ::�"fAttacfi(2);Ptof;Plahs;�;(2}sets�of�Bultding'Plans;?(�1j'sefof Eneryy^Fornti's;`R=t?-W`Pemi#ffar=iievir�construcUon, ' �� �
<br /> 4�..
<br /> �;Minimum;ten;(:1,q)workling:;days',;afte�.su6iiiitfal;il'ate:,-Requlreil.onsite;CbnstruaHon Plans;S`tomiwater'Plans w/Silt Fence installed,
<br /> � Sanitaiy Faciit�ess��rlydumpste.r.�;SiteiNorkiPermik-for�ubdfdi_slons/larc,�e prbJects - ` �� � ' ' . ��
<br /> COMMERCIAt Attach 3 com lete set�'of`Builiiiri�`Ptans�'lus arLife Safe Pa e• 1 set of Ene . Fomis.ft•O-W Permit for naw cdnstnsction.� "
<br /> t ) P 9 P iY 9 ,t ) T9Y
<br /> Minimum ten(10)working days'after�submittal'date. Required onsite,ConsWcdon Plans,Stormwater Plans w!Silt Fence Installed,
<br /> Sanitary Faciiltles 8�1 dumpster.Slte Wo'rk Permit for aii new'projects"s�AiCcommerciai reguirements must meei compltance . :
<br /> SiGN`PERMi7 At#acti"(2)sets of�Erigineered;Ptan's:;;f,��;.:��.:`, _ , , �, • ` �
<br /> - "*"PROPERTY SURVEY re,qui,red for,all NEW conshuctlon.
<br /> Directlonst . ` .--�- ..:, . ,.
<br /> Fill out applicatlon completely.
<br /> Owner&Contractor slgn back of appltcatiast.not�rized
<br /> if over�2500,a Notice.,of Commenaement is requlred. (A!C upgrac9es avor S7S00) ,.
<br /> -,.:;:;�,<<4�-
<br /> " Agent(for fhe t�ntr'actor}or Power of"Attoiiieyw(for tttie�owner)w6uld tie sameone wtth�notarized letter from owner authorizing same
<br /> OV,ER THE COUNTER�P,ERMITI'ING�• -•�� -�(Front-of Application•Only)��.� ` :. � �
<br /> Reroafs if shtngles Sewers Service Upgrades A/C Fences,(PIoUSurvey/Footage)
<br /> Driveways-Nat over Caunter if an public roadways..iieeds ROW '� � �
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