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a�saso-oo2o City of Zephyrhills Permit Application Fax 813-780-0021
<br /> Building Department
<br /> . , . .
<br /> Date Received Phone Contactfor Permtttin �
<br /> Owner's Name (�R� �U� . f�� �I , �N�l�.$7(�G�T l , Owner Phone Number
<br /> Owner's Address � Owrner-Phone Number
<br /> Fee Simple Titleholder Name � � d�� �r �GS� Owner Phone Numbee �/�—7�J� - r9�G� ,
<br /> i,�r . •�
<br /> Fee 3lmple Tltleholder Address �"
<br /> JOB ADDRESS � � � �(fcI• 3 c5 oG LOT# �
<br /> SUBDIVISION PARCEL ID# -
<br /> (OBTAINED FROM PROPERTY TAX NOTICE)
<br /> WORK PROPOSED `� NEW CONSTR ADD/ACT Q SIGN Q Q DEMOLISH -
<br /> INSTALL • 8� REPAIR
<br /> PROPOSED USE . Q SFR Q COMM Q OTHER cC 4 ic41
<br /> TYPE OF CONSTRUCTION Q BI:OCK '" Q FRAAflE [� STEEL Q,
<br /> �4 I� {
<br /> DESCRIPTION OF WORK �fi�Uq� C�IGhJ ! pJi �t� S-ToN T�US tJ/I�1C�J vG� (�D r �
<br /> BUILDING SIZE SQ FOOTAGE�� HEIGHT . .
<br /> QBUILDING $ -°�;.-�:; _.� . ���--_ ` �
<br /> VALUATION OF TOTAL CONSl'RUCTION
<br /> QEI:ECTRICAL $ AMP SERVICE Q PROGRESS ENERGY � W.R.E.C.
<br /> OPLUMBING $
<br /> �MECHANICAL $ VALUATION OF MECHANICAL IfVSTALLATION 1 � l ` ��
<br /> D D
<br /> QGAS Q ROOFING .Q SPECIALTY Q OTHER ' 2 ( �
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES. NO
<br /> BUILDER COMPANY
<br /> SIGNATURE REGISTERED Y/ N FEECURREK Y./.N,
<br /> Address Lfcense#
<br /> ELECTRICIAN_ - COMPANY �
<br /> SIGN�►TURE � REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address _ . �.License,�# r—
<br /> PLUMBER . . COMP.ANYR -� -
<br /> SIGNATURE � REGI3TERED ,Y/.-N • FEE CURRE� Y/N.
<br /> Address License# ,� .
<br /> MECHANICAL � _ - . , �.COMPANY, �IGG-f ec� � i,,..� �- A'RGq
<br /> SIGNATURE .. REGISTERED . _. N ,FEE CURRE� Y./N •
<br /> Addre�s� � �I�S �•A�c� S-f`.�� T�r-r g FG �3 3 ,7� , '. ucense# G'AC($(7�S�
<br /> OTHER ' COMPANY �
<br /> SIGNATURE � � ' REGISTERED Y/1N... ' �_FEE CURRE� ;. /Y/-N�..
<br /> Address - � _ �'�-:.��-� .. � _ .. � . - ' License# �
<br /> a,.� - , ., --� ._. ., .,c.�.,;-; ..,;.r. , , .:: ..�;,; ., ,
<br /> RESIDENTIAL: -�Attach(2):P.,IotfP.,lans;`a(2)sefs:of�BuililingsRlanst(1)sef of;Energy�Forms;R-0-W Permit:for new,construcfion,_..
<br /> �- -�•..,
<br /> � Minlmum:.tem(10.);worlting;days_aftec,sutiinitfal:date.�Requfred`onsite;<Constiuction�Plans;tStomiwafe�'Plans w/Silt Fence installed,
<br /> � 'SanitaryFaGlities�:&�1;;dpmpster;_SltegWo,r,k�Permit.for"subdivislons/large,':pro)ects-,`;:;:�:_` .` '� ' •
<br /> COMMERCIAL Attach(3)°complete`sefs`of B'uilding Plans`plus'a Life Safety Page;�(1)set of Energy Forms.R-O-W Permit for new�construction:
<br /> Minimum ten(10)working days'after submlttal date. Requfred onsite,ConsUucBon Plans,Stormwater Plans w/Silt Fence installed,
<br /> Sanitary Facilities 8�1 dumpster.Site Work Permit for all neinr�projects.All commercial.requirements must meet.compllance
<br /> SiGN PERfNIT AttacK"(2)'sets of`Eiigineer.ed'�Plans�;:;z;��r�-- .:;;��.� :�� : _ '
<br /> ""PROPERTY SURVEY reguired,forall NE1�1 construction.._.
<br /> DlrecHons: ,., � - � �
<br /> Ffll out epplicadon wmplately.
<br /> Owner 8 Contractor sign back-of applfcaUon,notarized
<br /> If over 52500,a Idotice,of Commencement Is required. (AIC upgrades over�7500) •
<br /> �r,•,-.:�;.�x
<br /> " Agent(for th'etcontractor)'or:Powe��of Attomey�(fo��tFie`owrier)would be someone with notarized letter from owner authorizing same
<br /> QVER THE COUNTER.PERMITTING.�-•, -- {Front-of Application Only). - � � ���
<br /> Reroofs if shingles Sewers Service Upgrades Pi/C` Fences(Plot/Survey/Footage)
<br /> Driveways-Not over Gounter if on public roadways.:"needs ROW - � •�
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