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a��-��aoo2o�� City of.Zephychills Permit Application Fax 813-780�0021
<br /> • Bultding Department
<br /> Qate Recelxed . _ r�a;< �- _ �k,.
<br /> �,��d•. � Phone Cciritscttlor:Permittiri e ___. _.. . .�.w. -. -
<br />' Owner's Namg _ . . .- �� .. .-:.. ..- ". Glwner Phone Namber y�.;��J~�. � _ . _.�
<br /> Ownsr's�Address < � �t�� - _ - ._ Owner-PhoneNumber^ � -- - , • � t,�
<br /> Fee Slmple 7ltleholder Name �� � � Owner Phone Number_ �- � ��
<br /> -x. _ _ _ �.. .
<br /> , ' . _. ';_..: .. ..:_..�`.. :.,�_ �'. _. .:. .._, ,�
<br />� Fee Simple Tltleholder�Addreaa � - - - ��" " _
<br /> JOB ADDRESS � I �. F . _ __.. :,. _..._,_. - __, rLOT# ^Y � � (;:�
<br /> SUBCIIVISION �� � ' �'` RARCEL•ID# ' ��� ��Q-:•f:L �1„�} .�,�... - ��
<br /> ' � , � . .., . ,�,: . � �_(OBTAlNED-EfIOM+•PROPERTXTAX'NQTtCE}; .... :
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<br /> WORK-PROP,OSEU � �r NEW'CC1N57R ' "'.�,��`-ADD/ALT `��� � SIGN'� � Q'" '`y ` `[�"`�'DEMpt»ISH -
<br /> +� WSTALL �. 8' REPAIR ,
<br /> PROPQSED•U.SE, `. � .SFR . �`� �CtaNIND' � �� - OTHEi2. - -
<br /> TYP�'OF CONSTRUC110N'� ,[�` �BLOCK �' �[��" 'F�RAME ;�]_ STEEL. .[�,.;� '- � :+.,:.~�.,':':,.,� .
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<br /> DE3CRIPTION OF WORK ^ � ��„ y"��Q
<br /> BUIi:DING�SIZE �����!_:�� $p;F00TAGE.�.��„- . ,w .HEIGHT '
<br /> QBUtIDiNf3' ' - $ ( . ,. ��.a� •,:.� ',, --"�r, ,� ,� _ _ _ ., '- , . ,
<br /> , ��""�_�:. VALUATION`�IF'1'�OTAC CONS1'Rl7C"TIO� '�� .
<br /> . �
<br /> QELECTRIGAt . ($ ���� ,AMP SERtilICE Q, PROGRESS ENERGY Q W.R:E.C.
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<br /> QPi:UMBiNG �� , � G ���
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<br /> [�MECHANIGAL $ VALUATIOt+!OF MECHANIGAL[NSTALL/lTlOi�t
<br /> . �!�""'�
<br /> QGAS �'�. .; . 1200FitVG=;-Q. SPEGiA1.TY �-� OT31ER t �
<br /> FINISHED FLOOR ELEVATIONS � = � F1.00D ZONE AREA .QYES NO
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<br /> i Bui�.o�R �co�npaMr c�W1.�2 �.c2�'
<br /> SIGNATURE REGIS'rE�tED Y/ N FEECURREK „Y,/.N:.. .
<br /> Addre�� � . ' . Llcense# I �
<br /> ELECTRICIAN , `COMPANY` �
<br /> SIGNATURE `' REGISTERED Y/ N F�cuRi�� Y/N ..
<br /> Addres� r. . " •.L•Icense�#, I� �
<br /> PLUMBER , • COMPANY�� ..-, r �
<br /> SIGNATURE ,,. ,�GIstERED • a�Y/�-:N '� � ��E cuRRen Y/N.
<br /> Address " . ,, l:icen'se#�� _ �.
<br /> � . . :- - y .� . _ .:z� . � ,_ ,
<br /> MECHANICAI: _,COMPAFiY�:.
<br /> SIGNATURE " ' ' � ` -,REGIS7ERED. '._..Y;/ N; .. .. .:FEE CURRED - ••�Y%{V = ` � � �'
<br /> Addrea's�' � _ � :` _ , < . ,
<br /> _ . _. � ,ucense# � �
<br /> a.n��a .. - - � - ... � , cpr�Par� �__ - - .. +,. ..� ,-
<br /> SIGNANRE - - � REGIS�'ERED Y/.N.. ' :.EEE;CURRE� LY;'l�N:=..:'.
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<br /> Addresa� .� ,,,���.t;�: � - ` - ' �Licen"se#�•`�. ��
<br /> -- rti;; - .-- '•d^ _.,x:. � - �;xu.?+:.s�,-a.:.;, �.#;�..,.• _ ::F�;-:.,: ., . .
<br /> �•,,�;. .z�r.�:j>�,�.._:: - . ..�.�: ' .,; . � .�,;� ` .�X__. ,
<br /> RESlDENTtAL�� .�=Ritactiit2j;,Pio:t�Pians;,��2)`sets:of�8uitding'Plar`ts;,(1)�setoE;�nerg`yjForrn's;R=O=W�Fermi,t.for�nerrv;constniction,_ „ -
<br /> ii t"n I - � �°:.,�:, �T, ,: ; - e".4f� � . $ t:Fenqeinstalied,
<br /> -.,;�,Minimum�.ken(;I;O);arorking;days�af�e'r,;"s ti iffal�ii'afe�-Requ ied onsl�e;FConstrucHon�Plans;�SEormwaf rplans w/: ii
<br /> Sacitta �FaciliUe,sx&�1Sdum ter;=Slte*iNoric�PeimlE.tar;stiti.dtvislO,risila e ects'.`��"--` ,- _ � -
<br /> , � s � t_.,i?S _._. !,9.:p„!�1.1 `.' :rA�;``;^,°. :;;...: ..:........ ..
<br /> COMMERCIAI. �AtFach�3)'i�mpiete s�is�qfBi�iiding Ftens��pius�a�t�fe Ssfeiy Page;�(1}set of,Energy-Forrns:R-O VII Petmi4 for nevd�cianstruction:
<br /> IVlinlmum ten(f0)wo'liing days after submittsl date. Requlred onsite,ConstrucUon Plans,Stormwater Plans w/Sflt Fence installed,
<br /> Sanitary FadliNes&,1 dumpster..3lte,VYork Permtt•far,ali,newr`pro�ecfss�Aii�comaserdaf.requt�ements mc�st meet compitance '
<br /> $1GN PERMi7 Aitaich�2j""sets of."Eng`iiieiared�Plans:s�itw�:sar ..- .... ` - � ` .
<br /> •`""RROPERTY SIJR1%EY`regulred';for aII�NEW�canstrucdon...
<br /> Directians:., .. � ;;��::,;.:;:�....� . _ , �° ` , r_., _ . .. .
<br /> Flll:out eppltcatlon completely.;
<br /> Glwner..&.ContraGtor slgn bacctcc-of,:apgitca�an,notariz�l
<br /> If over�2500,a.Notico af.:Commencement,la requlred. ,(NC,upgrades over ST500) >
<br /> �. ' ,..,,,;Y,��se�,�.;,,.: _ .
<br /> Agent(for.tfte iiontractoc)�o7.;F'o"wer,of.Attomey(fo��tlie owner}wauld be someone with notadied letter fram owner_suthorizlrsg same .
<br /> i 'DV.ERTHE'COUNTER.,PERMITf1NG�- • . (Front-ofApplicatianOnty) - '
<br /> � Reroofs:If shingles Sewers � Service Upgrades-7VC' Fences(Plot/Survey/Footage)
<br /> Drlveways-Not over Counter if an publlc roadwayis.:needs ROW - ,. , `
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