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813aeaoozo City of Zephyrhills P�rmit Application Fax 813-78Q-0021
<br /> ,; u Bulld�ng Department ,
<br /> Date Received 1�� 1 � -- � � :pltone-Contaet:far Perm[tNn :_ �t � �1 �`"� — t`�Q �
<br /> 4wner's Nama � �� �� Owner Phone Nambar
<br /> Owner's Address � - Owner Phane Number �� �
<br /> Fee Simple Tideholder Name �— � Owner Phane Number � �
<br /> t,,� �"_
<br /> Fee 3lmple Titleholder Addres� '°
<br /> JOB ADDREBS �/� �� , �v ° `�`� � LOT# ��
<br /> SUBDIVtStdN lS�e �"'ti�'"� � p,ARCEL ID# - •
<br /> (OBTAINED FROM PROPERTYTAXNOTICE)�
<br /> WORK PRQPOSED `*NEW CONSTR' ADD/ALT � S1GN' _[� , Q DEMQLiSH
<br /> � INSTALI. ,8. � REPAIR,
<br /> PROP4SED•USE Q SFR �: COMM C� OTHER
<br /> TYPE OF CQN3TRUCTION : [� BLOCK ~ Q FRAME �] STEEL. [� -
<br /> DESCRIPTION 0F WORK F �� �� m�-� OV�1 �e I
<br /> -
<br /> BUiLDlHG SIZE •� � SQ FOOTAGE��, , HEI(3HT C �
<br /> Q�ut�d�NC'" � � VALUATiON OF TOTAL CONSTRUCTION
<br /> ..J
<br /> EI.ECTRICA� � $ L'� ��� AMP SERViCE Q PROGRESS EhtERGY �Q W.R.E.C.
<br /> C� -- J
<br /> QPLt3MSIN{'a �g�`� `
<br /> QMECHANfCRC �>�. VA4.UATION OF MECHANEGAI tNSTALtAT1aN ,� C G � t �
<br /> QGAS Q ROOFii+1Ca ;Q SPECIAI.TY �� - OTHER s r � t��j
<br /> t U l�
<br /> FINISHED FLOOR ELEVATIQNS FI.00D ZONE AREA �YES NO
<br /> BUIl.DER COtVIPANY �
<br /> SIGNA7URE REGISTERED Y/ N � FEE CURRE� Y/N
<br /> Addrsss Liaanse#-������
<br /> E�EGTRtCIAN. ' �Uti;,_j �,� ,� coMgAx7r : �,,,,;, S.�t-e��..l S�tu,.�.-� Z ,�c
<br /> SIGNATURE `���+_�,,. REGISTERED Y/ N FEE CURRE� Y/N
<br /> �aa��� 1 �,�: C�-Si—c.,� �.� `,�,,�— ���,,��..
<br /> 6`�,� �336��7 ucense#.; ..�C I.�o aF"4/` 9G�
<br /> P�UMBER � . . . GOMPANIf• ` ,
<br /> SIGNATURE � " _REGISTERED •. Y./ N FEE,CURRE� Y/N
<br /> Addre�s Ucense#y��— �
<br /> MECHAl+EICAL� � , � ,., CQMPAt�lY: °
<br /> SIGNA7URE �,_ REGISTERED , . Y./_ N FEE CURRED Y/N-
<br /> Address , f License# �. � �
<br /> OTHER ' ' -� � ,CONtPAF1Y y
<br /> SIGNATURE �• - � � { �"REGISTEttEa Y/ N?,_. FEE CURREP Y/N
<br /> Addr�ss _. . ., •:.,V,,-r _ . „ . _ - License#•I � � ` �
<br /> . ,.._ . . .. , , ,., _. , .... . . _. ,
<br /> �RESIDENTIAI:°. .._Aftach{2};P:,tcit.P._lans;..{2}sets=of:Bullding;Plans;'.(1)set'aFEnetgyt��Farms;:�F2=4�W'Perrrilt'for'neutircaristivattan, ' '
<br /> . -�Minimum;;ten;(.1.0)�,working;days;aften.subriilital ilete:4 Requlreil.onsite;�ConstrucHon•Plans;8tomnwater'Plans w/SIIfFence installed,
<br /> 8anitary FaGlttles;&�,17ilurnpstar;Site=WorkFPem�It#cr'.subdivislorisllarge grojects - �: . :;` ~ ' .
<br /> GQiflliUlERC1Al. - Attach{3}`cosnpletei'sets'of Bulldiiig Plans plus`a Gife Safeiy Page;(1)si�t of Eaergy Forms.R-Q-W Permit for new construcUon.
<br /> Min(mum ten(10)wo�tcing days afker submittal date. Required onsite,Construction Plans,Stormwater Plans w/Stlt Fence installed,
<br /> Sanitary FacfltUes&1 dumpste�.Site Watk Pecmft far al!new proJects:-A!I comrr�ercial requfremenLs must meet compilance
<br /> Sl�N PERMlT Attach`{2J sets af Engineered�,Plans:„:,:�:.•�, "� ,. .� _
<br /> ••""PROPERTY SURVEY reyulred for all_IVEW_canstruction.
<br /> Dliecttans: . . , .
<br /> Ffll out appiica8on completely.
<br /> Owner&Conhactor sign back of appitcadan.rsotatized
<br /> if over 52500,a Notice pf Commencernent is required. (A!C upgrades over 57500)
<br /> " Agant(for the�conVactoF)`arPower"of"Attomey'(fo�Jtt►e�owne�)would be semeone with notarized letter from owner author�zing same
<br /> OVER THE COUNT.EI2;PERMITTIFtG•--�� --(Front�of Appticatton Onty)
<br /> Reroofs If shingles Sewers Service Upgrades A/C Fences.(Piof/Survey/Footage)
<br /> Drivewaya-Not over Counter if on pubiic roedways..neects ROW �
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