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s�saeo-aozo City of�ephyrhills Permit Application Fa�-813-780-0021
<br /> # ' � � Building Department
<br /> Date i2eceived � �f,, . . ' , .
<br /> r� �d"`' A Phona Coiitai:t;for`Permittie`�," �
<br /> Own+�r's Name u � 5� e���Y� C3wner Phane�tamber "� "
<br /> Owrner's Address . �•. - ' ^ � � � Y ,�/� �Qwner-Phone Nium�er t �
<br /> Fee 51mpIQ Tltlehold'er�Name � • �� - � " Owner P!hone Nu`mber��.� .,� ,
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<br /> Fee Simple Titleholder Address .: - �" _ -
<br /> JOB ADDRESS - - ` _ „ LO�'# �� '
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<br /> SUBDIVISMON � �� '- = ' '� PARQ�L'ID#' " . _ .. .
<br /> � - � �.=(OB7IUNED'PRONf PRpFERtY TAX=NCTlCEj
<br /> WORK PROPOSED - NEW CONSTR � ADD/ACT � SIGN Q� Q h DEMOLISH �
<br /> � INS.T�U;L 8 �REPAIR� -
<br /> PROPBSED:-USE:. Q: ' 'SFR �" � 'COiv1M' [� 'O'tEiEF2 r ' .
<br /> TYPE OF CQNSTRUCTION;'' '"Q �`BLOCK�.' .C]��' FRANiE ��] STEEC ��, . ;.
<br /> DESCRIP710N�OF WORK p� a� �,� !J �� •
<br />�� BUILDING SIZE.. ' C ' ri� SQ.FQ07AGE J.. ;. ` :�tHEIGHT��.,. ,
<br /> -- 08Ut1.DING ,, $ r -�:�_,�+:�;.. :.�.r.:,�rn.;., ._.. , _. . . ,
<br /> , ���"�► �. VAL'UATION`�OFaTCiTAL=CONSI'Rl`JCTIOPI . .
<br /> QEI.ECTRICAL �� AMP SERVICE �Q PROGi2ESS ENERGY Q W.R.E.C.
<br /> QPi,UMBlNG $ .
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<br /> QMECHAiVICi4l . ` $ - : , �VAI.t1RTtON;OF M�CHANIGA�IitifSTALEATION -
<br /> Qr�s o. . ��Q����.: ,o S�E���n o� oT�E� .� . .
<br /> FIfVISHED FLOOR ELEVATIONS � � FLOODYZONE AREA C]YES. NO� .
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<br /> SIGMATUti� REl31STERED Y/ N. FEE CURRE�' '<. Y/.N,_- ,
<br /> �►ddre�s ` ., . Libense# �� � � I
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<br /> ��G4�IVV�yt.�i � , ' ' ' ., /� 1t1�p w��V ' .. ._ _ , � ' .'
<br /> ys y�1�IfA1\f
<br /> SIf3NATURE '�' ��is�R�a Y/ N F�cu�en ' Y/N
<br /> Addreas } . .. .., � .` �License#:•I �.� ' �- •---�
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<br /> PLUMBER - , . CO�APANY� - , � . ,, °
<br /> 31GPIATURE � . . � _� - �RECiISTEREOt� - . �:Y�/-:N , FEE�cuwtEn . .:ypfV_ -
<br /> Address s - . - " - - . ..LJcense# � - • �I
<br /> MECH�IPItCRE:' ' �._ . . � . , . :GQMPANY , � .. . - �
<br /> SIGNATURE , _ . `" . , � ' _ . it�Ca�,�S7ERED . - aY./~N_ ,.�:CURrt�n �Y%N �
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<br /> �Address:--, ;� _� _ .._ _ ` :., .t .. � . -, ' , ,'- �, ,License#-� � _.
<br /> OTNER " .�, - :�_ ' � ` . - _GOMPANY - , - . - � - � ,
<br /> SIGNTU E;- . ,. . . . ., . ,:.,
<br /> A R _ "_ , '•_ ' _�REGIS7ERED. _ Y/.N. �t FE�iC,URfiEA' ;:Y.:/Plc� , ,
<br /> Addrea� _- '*.,,-, �.�;,qs";,;<:�;.,, , _ �j ., ;� - � '�>' � . rLlcense�#��t`- ' ' • ' �
<br /> RESEDENTIA� -�.`Rttacti�2�.:Ptof.P.ta�s�;2�;setscof�Bu�tdTn`��rPlans;��i�,sef,of�ne'";';Fori»s��=R=Gi={N�Pertrilt:for�ne";:�nstrucfion,_.. , ,
<br /> . = t ) _ �� ) , 9. { ) �9y .._. �,. . �►., �
<br /> :r Mlnimum?ten�(.1Q)kworltigg;days;after,:submlttaf;tlafe:=�Requlred onslte;�GinsfnucBon;Plar►s;-Sto"rmwate�Plans'vii%Silt Fence.lnstalled,- -
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<br /> " Sanllary:Fadllti�sr.&�14�c�ur�ipstsr,Si2eiW�orli,f?ettiait,for.,sutidivf'slOrisllatge'projects,.��:-_°�.'':��� �-�� . _.`_ • _ � ,.� . _
<br /> CONIMEi2Ct�L Attad►(3j'�COtitpl8te`SetS'Of BUlI't311Sg PiAI1S p�1uS 8'Life SBfety P81a6�(1}set of Energyr Fqrms.R-O-W Permit for new c6nstruc8an.
<br /> MiMmum ten(10)workMg days'after submittsl date. Requlred anslte,.ConsWcBon Plans,Stormwater Plans w/Sllt Fence Installed; , �
<br /> Sartltary�Fadlities�lydum�tster..Stte.Work..Permlt for all�aew:ptoJects:%4!i'cammerclakcequfrements must,meet'campilance .,
<br /> SiGN•i�ERM1T Attacti(2)sefsof�ag�I,jtieer,edEPla�is:f;�e;��rwt'.��:.<°��'.� .. . - .:. . . . � .
<br /> ••••PRQPERTY.SURVEY reguired for aIIrNEW coqstrucUon.:_.._ - ~; ` - „- � ,� . �
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<br /> �Directions: .. ..-_,,:-;_ . .._. -- _ _ _ ,. .
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<br /> FIII outapplicallon completely, i
<br /> �Owner&Gantraetoc stgn badc•ofappllcattan,natariied ',
<br /> 1f over�2500,a:Notice,of Coromencement la required. (AIC upgrades oyer 57500).._, . _�� � " �
<br /> 'A�"a„_a;��d�,.r,7a'-i._. _ . ._... �,,.,,..,._ • ' ".: - - - - _ .. ..
<br /> " Agent(fot ihe contractot')`4T=Pouier of�Attomey(for#he:owtier)vi+ould be scmeone with nolarized leiter ftam owner suthorizfng same , �
<br /> OVER THE-COUN7ER�.PERMITIING-�--' '(Front;of-Appllca8on Onl`y)�r � � • . �
<br /> Reroafs if stiingles Sewera Service Upgnades A/C = Fences,(PIoUSurvey/Footage) ' � " ' - -• _� , ,
<br /> , ...�._._.�_..._ .�_...:.:::- .. -v -.,._-- :-�;,�. .�.r..,. .. • .. - ._... ..._. _ . ,. , .
<br /> Driveways-Not aver.Counter if on�pubOc roadways.:`neiad'§�ROW� ' �� � �
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