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s�s-7saoo2g Cify of Zephyrhilis Permit Appiication Fax-813-784-0021
<br /> � Butiding Depaetmant
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<br /> Date Recelved -,�r'��� , ..�:.°,phone Caiitact^for Permittin���"� "�!I?" ��' — �� �
<br /> Qwner'a Name �r R�l .�5.r',�,r , .�r . Owner Rhqne Number , � ��'r,�� :t� ,., � _
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<br /> Owner's Address +�� � O �,�r{� ' .'�' �0 . �� ' Owner•Phone Numtier ' � ��.. �
<br /> Fee Simpls Titlehcldec=Name��� , _ _ - . Ownec Phone Number .� , � �
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<br /> Fee Simpte TiHshotilec,Addre�a '•., - . ` �
<br /> JQ6 f,►DDRESS t.�/ �/�/!'I./// GG/�'I . 1.0'f# C� - �
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<br /> SUBDIVI310N ' PARGEk:iQ#' � ' - ` ,
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<br /> WORK PROP..OSED "' NEW CONSTR ' ADD/AL•'T '�' SIGN �i[� [�;� DEMOLISH• , -
<br /> INS1;ALi, REPAIR' - � ��, ��
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<br /> PROPOSED USE. _ �<� SFR '[� COMM , `�� O'i'tiER;- ' , .
<br /> TYPE OF CONS'TRUC'f{ON� �-�[�`'' ""BCCiCK 'r'[� '" :'FR/lME Q STEEC, Q, -'��
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<br /> DESCRIPTIQN OF�WORK t '
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<br /> BUILOINGSIZE':� ` ��SQ:F,.00TACiE. < <,HEIGHT �, _
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<br /> - . [�BU{�.DiNG $ 'Y.h "';}:C:.. . ttFz" '•. _. _ ._. ;
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<br /> 'VALUATION"dF"TO'I'AL CONSI'RCICTION
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<br /> QELECTR1GAt r$ . AMPBERV{CE ' � [[�' PROORESSENEF2GY Qrf W.R.E.C. ,
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<br /> QPl:UMStNG ��/.
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<br /> MEGHRNlGAI" $ 7� �O �VALUATlON�OF MECHANECAL(NSTALV4TIt7N � -`": �f �� � .- �
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<br /> QG�AS Q : � E20dFiNG;,;•Q .. SPECtAi.n Q' .OTM�R� .
<br /> FINISHED Fi,00R El.EVATIQNS �� FLOOD ZONE AREA .�YES. NO . ,. ,
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<br /> BUiLDER COMPANY ` � � , � � ' �
<br /> StGNATURE �E�isr�aen Y J N. . �E cur�n' , Y i.N:.� :. : _ , , .
<br /> �ddreas . W , . _ . Ucense# �� �
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<br /> EI.ECTRICIMI�,_:, . . .„ - `COMPANY' . � - � , � �� , �-
<br /> SIGNATURE � REG1$TERED Y/ N �E cur�� `Y°!N=�. . �
<br /> Address � � . � I � . , ., .� `Ltcense.-#.��_" -� • �
<br /> PLUMBBR , � . . . COMPANY:. :;,: :� :: :,- , .:ti'� '
<br /> 5lGNATUi2E� � � ,..a {.a•• . ;;REGt$TERED� - ;:;r,'�� •:<Y`l.�AI: � �,: �E:cuRttER•� .: :•Y/N�_, _
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<br /> Address � _ � � _ , Ucense#_� � -
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<br /> MECHANiCAL,� � ° , .. -..C,OMPANY� ufa4(�li�:s_. - .o,�- �� e��
<br /> srr��►ruRe . -._.. _ - ��G�,��;r �.Y.1 N,-= . , cuR3t�: "Y/-tV.=, . �
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<br /> Address:>.� y.Y.. _ fifi,Ki ` �- .� ,,,r `3.��'�� ,: .� ... , �:i:►�ns�.# ��G o y3�,�'�� �
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<br /> OTHER �� � • . w;� . • , , . .. GO1yAPAP1Y.,_ c. .... ....' , ,..., ;.. �.,, ., ;� - �
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<br /> SlGNASURE. - � - ... . , ^ , . , _ �:REGtsT�a .. -Y t:.N..`s -. :.���'CURi�t� - :�tY.!•Nf� .
<br /> ----� A�ddeess _ J ":F,.. .1: rt;:5.w;;a; . - .=;• . .. _.,, -, ` - ' . 'Lic�nse#�(', �
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<br /> RESIDENTIAI:: '�Ait�ch 2'..Pl'ot;Plans;z3}`.sets,of�8�11di'ng°Plans;°(1);`sefofEnergy�Forriis;R-0=VU;P.,er►rilf:forqevVoonstrucUo�; _ . .
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<br /> �:_Mlnimum:ten,�(.i,.0),wartting�;da,ys;after;sutiinittal�ilafe:{:Requited cnsite;�Gonstnic�on�Piaiis;SEainiivater Pians w!Sitt Fence lnstalted,
<br /> _ , .:SanlfeiyFedlfaes&s�l8dup,►Psterv�itetWorlc�Permitfqrsutidiv(slons/lat�ge`projects}'�;:<x's�Ya;"�'•'��`'';`.�: �. '_ ,.. -�..•_ , .. ,: . _ .
<br /> COWIMERCiAL. Attach(3j`acinpiete sets af"8iutiding'Plans`plus a life Sefety Pege;(1)set of Energy Forms.R-O-W Permlt fo"r new constniction.
<br /> Mlntmum tea{1Q)warlcing days at�er snbmtttat.date.'Fteqnired onsite,.ConstructEan Pians,Stortnwater P1ans w!S1{t Fencs instatted,,,
<br /> - Sanitery_.FadBdes&1 dumpster.,Sfte_.W.otk Permlt for�Il;new�proJeots:`All cammerctal:rsqulrements�must,meet.compllance _
<br /> SiGN.PERMtT Atta�'2 sets af'En 1`eered�Pla s.;•,.r.,.;c",���:.` ....:>,,w , . , _. = , �� ,
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<br /> •�•PRiJPERlY.SUR.Y`,EY:regulred.fqr,a11NE1tVconstcuctio�►:: � - -- - _ -
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<br /> Dlre..cNons: =;'e�:;:.:.-. .. .. - .. _ _ _ . ... .. __.. �.. _ .
<br /> Ei�t out appfica�an�mpSetely.
<br /> Clinrner 8 Contractor slgrt back�of.appllcaUon,no�rfzed
<br /> If aver 52500,arNotle:e qf_Comroencement is.required.--(AIC upgrades over 57800),_,_ _ � ._-
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<br /> Agent(for tfie"contractor)or.Power of Attoiney'(for tFie'owner�would'b'e�'someoneYwith nota�ized letter irom owner authariztng sama
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<br /> 'OVER'THE COUNTER.P.ERMITTING-=`�--•;.:(Front of-ApplioaBon:Onlyj`� .-. .�
<br /> Reroofs if shingtes Sewers Ser`vica Upgredes AlC Fences,`(PlotlSurvey,lFootage) . - -- _ ,
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<br /> Driveways-Not over Counter ff on putatic roadways..needs RbW
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