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<br /> 813-780-0020 City of Zephyrhills Permit Application Fax 813-780-0021
<br /> Bullding Departrnent .
<br /> Date Recelved -
<br /> ' ' Phone�Contact"for'Permittin � -
<br /> � .. . _
<br /> Owner's Name Sy-s�/� �,S� Owner Phone Number
<br /> Owner's Address �� s � /��/✓S �T 2 Owner-Phone Number
<br /> Fee Simple Titleholder Name Owner Phone Number -
<br /> Fee Simple Titlehold�r Address '•�
<br /> JOB ADDRESS � z l.� S�E �N^� �` < LOT# �
<br /> SUBDIVISION �l�l��/` .�9p�.f PARCEL ID# �:�^e2-� -� —�� -� - �(�B�-��1,j� � �
<br /> (OBTAINED�FROM PROPERTYTIIX NOTICE►,
<br /> WORK PROPOSED "• New coNsra ADD/ALT Q SIGN � Q DEMOLISH -
<br /> WSTAtL - B, REPAIR
<br /> PROPOSED USE Q SFR 'Q COMM Q OTHER
<br /> TYPE OF CON3TRUCTION� � BLOCK �' Q FRAME [,� STEEL Q `
<br /> DESCRIP110PIOFWORK � /(.U9� OdLI�� Wl�� . 3O ,lij/ � O�l�'G Sl�!/�G�L�
<br /> BUILDING SItE SQ FOOTAGE�� HEIGHT . • -
<br /> QBUILDING $ VALUATION-aF"TOl'AL CONSTRUCTION
<br /> ��DD
<br /> QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E:C.
<br /> OPLUMBING $
<br /> E _ �� i l � !/ l �/ �
<br /> QM CHANICAL $ VALUATION OF MECHANICAL INSTALLATION. I ` I
<br /> OGAS 7/� ROOFING. Q SPECIALTY Q OTHER �Z�
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES. NO 2
<br /> BUILDER COMPANY
<br /> SIGNATURE REGISTERED Y/ N FEE CURFiE� Y./N
<br /> Address Clcense#
<br /> ELECTRICIAN COMPANY
<br /> SiGNATURE - �'"' REGISTERED Y/ N FEE CURRE� Y/N
<br /> Addreas � L-Icense�#
<br /> PLUMBER � COMP.ANY � -
<br /> SIGNATURE � Re�isreReo , . Y/�N • FEe cur�en - Y/N.
<br /> Address License# ,
<br /> MECHANICAL ,COMPANY , . �i
<br /> SIGNATURE ` REGIS7ERED Y/-N , FeE CURrte� Y%N .
<br /> Address ` � �� License# .
<br /> OTHER r- - � � , CO�VIPANY . ���lN �09yl�✓G
<br /> SI(3NATURE �'�iA,i�-- ' � REGISTERED ' Y/ N . , FEE CURRFJ� , Y/�N... �
<br /> Addreas , 0.�0 , . 3'=, ��- � C6 •` '"�/� "� License# �610�� �
<br /> e .i, .��Y � , _i � _
<br /> . _
<br /> RE3IDENTU4L:: ���Attach(2)?Plot;•Plans;..(2)s`ets:of'Buildi"ng,;Flans;(1j sef of�Energy�Fortns;�R-O=W;Pennit for5new.,construcfion,,_
<br /> :. , ,_�;.,,.:. .. „ y.,.,
<br /> ,: Minimum�ten:,(1,.0)sv�(orking;days afte�;'sutimitital=d"ate:?.Required onsite;-ConstnicBon�Plans;-Stormwate�'Plans w/Stlt Fence installed,
<br /> , .�. ,SanlfaryFacilities,,&�,1,tidumpster:.Site;.Work-,Perrnitfor.:subdivislons/Iarge.proJects'��::';F;�=;." �'-: = - . . .
<br /> COMMERCIAL Attach(3j`complete set's'of Buiiding Plans plus a Life Safetyi Page;(1)set of Energy Forms.R-O-W Permit for new construction.
<br /> Minimum ten(10)working days after submittal date. Requlrad onsite,Constructlon Plans,Stortnwater Plans w/Silt Fence installed,
<br /> Sanihary Facilitles 8 1 dumpster.S(te Work Pertnit for all�new:project§:All commercial.requirements must meet compliance
<br /> 31GN PERAAIT Attacfi(2)`sets of'Englneer.edrPlans:�;;;?=ss-�� ... .� ,,._ � z. . .�
<br /> '•`•PROPERTY SURVEY reguired for,all NEW�construction., ,
<br /> Directlon�: ;:�;_�� < , . .
<br /> FIII out appflcatlon completely. -
<br /> Owner&Contractor sign back.of appllcatlon,notarfzed
<br /> If over 52500,a Notice of Commencement ia required. (AIC upgrades over 57500) , ,
<br /> ,;:iit4,•kv�r:;" ..
<br /> " P�qent(for the contractor)'or:Power of Affomey(fo�the owner)would be someone with notarized letter from owner authorizing same -
<br /> OVER THE-COUNTER:PERMITTING -----•(Front,of-ApplicatiomOnly)- �° � ' "
<br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(Piot/Survey/Footage)
<br /> -� •- -. _ .,.... _ __ .... . - �,��,. �..,_. . ,
<br /> Driveways-Not over Counter if on public roadwajrs.:needs ROW
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