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a9a-�ao-oozo City of Z�phyrhills Permit Application Fax 813-780-0021
<br /> � a Bufiding Departmen#
<br /> Date Received � �� phone Contaat<for Perntlttin � �}J � �'tJ2�.
<br /> 4wqer's Mame G�, /YI � Owrnee Phone Humber ! �. `
<br /> ,,.... ,�
<br /> Owner'sAddress �"�) ,[�i' GG'c,g-.i� OwnerPhane•Number _
<br /> P � 'M ' � Owner Phone Number � ��
<br /> Fee Sim le Titleholder Name
<br />, { -
<br /> Fee Stmple Tltleholder Address ='
<br /> I JOB ADDRESS �U/ � J l� _ �B• �C .�'� LOT# �
<br /> SUBQIVISION 1 ������� ,�����f����rl P/4RCEL tD# -
<br /> (OBYflINED FRdAR PROPERTY TAX P1071C@),
<br />� WORK PROPQSED NEW COiVSTR RDDIALT [� SIGN Q Q DEMQLfSH -
<br /> INSTAkL e REPAIR
<br /> FROPOSED�USE � SFR Q CQMM C� OTHEF2"
<br /> TYPE OF CQNSTRUC'PION � BLOCK " Q FRANIE � STEEL, Q
<br /> DESGRIPTION O�WORK 1 � ,/� Y(, ,�� F Gt �� ��'
<br /> �
<br /> BU1LDlFiG SIZE � �� SQ FOOTAG���� HEIGNT �� � ` ,�'�T�
<br /> �
<br /> ��.
<br /> {I.DING � �L � �� VALUATiON bF TOTAL CONSTRUGTiON
<br /> QELECTRtCAI �'-� _��� AMP SERVtCE Q PF2{�GRE55 ENERGY Q W.R.E.C.
<br /> ��
<br /> QPLl3MBlNG �S �
<br /> QNlECHANICA! $ �YALUATtQN OF MECHAAES!lICAL I�USTAlG4TIQN � � �
<br /> � � ��
<br /> �]GAS Q t2QOFlNG Q SPECIAl.TY�� OTHER �
<br /> FINISHED FI.00R ELEVATIOiVS �� FLOOD ZONE AREA QYES. iV0 ���
<br /> �u����� � " j�� ' ca��� ��i���' �� _ 1
<br /> SIGNAYURE � REGISTERED Y/ N FEECURRE� ,Y./
<br /> .�, / _
<br /> Rddress % �/. . �'I Gt'/'�' License# �,_ ' �
<br /> ELECTRtC1At�! COMPANY
<br /> SIGNA�TURE � REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address -.License#, � �
<br /> P�U{VIBEFt GOMP.ANY�
<br /> SIGNATURE REGI$TERED Y/.�N FEE.CURRE� Y/N
<br /> /�Ctdl�SB LIC811S8# � �
<br /> MfCHAAir11lCAL GOMPANY
<br /> SIGIJATU1tE REGI&TERED Y,/ N FEE CURRE� Y/�N-
<br /> Address • License# �� —�
<br /> OTHEFt COMPANY �
<br /> SIGNA�TURE REGISTERED Y/ N FEE CURRE� Y,/<N .
<br /> ,. � ' � ' �
<br /> �ddre�s = � ,,,, ; ' _ Cicense# � �
<br /> . ,;..,,.. . ,._, ,...: ;..,. ,. . .. :. ,
<br /> R�S1DEl��IAI. �Pittaich{2}.Plot•:P.lans;�{2}"sets:of=8uliiitiig Flans;"{1)sef afEriergy�Forms;R-0-1N Perinl#for nev+r„c�nstruction,
<br /> Minlmum;ten:(�10j,working;days;after„subtnittal date.�Requlred pnsite,-ConsVuction�Plans;-Stormwafe�`Plans w/Sflt Fence installed,
<br /> . �3anitary Fecilifles:�al.,dumpster��Site�.Work:Rermit for sutidivislonsAarge proJects �' ,. '
<br /> COlI�iY1ERCtAt. A#tach{3}coii�ple#e sefs'of Bdlfdirig Plaris plus a l:tfe Safety Page;{1 j set af Energy Forms.R Q-W Pemrit#or new construction.
<br /> Minimum ten(10)working days'after submittal date. Required onsite,Constructlan Plans,Stormwater Plans wl Silt Fence installed,
<br /> Sanitary Facilides 8 1 dumpster.Site 4tVork Permit fior aII neinr:proJeats.All commercial requirements must meet complfance
<br /> S1GN PERMIT AttacE�{2)-sets of'Engirieered Plans.�:�,.,:a= .. . ,
<br /> •`""PROPERTY SURVEY required,for_aII,IVEW constcuction.
<br /> Dlr�ctlaras: , .
<br /> FIII out appAcatlon completely.
<br /> Owner&Contractar sigrt back.of appl4catton,natatized
<br /> tf over 52500,a Notice af Comroencement is required. {ArG upgrades over$T5o0)
<br /> ;r�-�;:�: F
<br /> " Agent(for the contractor)or'Powe�of Attoiney(f°r the owner)would be someone writh notarized letter from owmer autho�izing same
<br /> OV,ER THE COUNTER.PEi�t�ITTiNG {Fron#-of Apptica#ion Only}
<br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(PIot/Survey/Footage)
<br /> Drtveways-Nat aver Caunter if an pubiic roaduirays..needs ROW
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