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e�saao-oo2o City of Zephyrhills F'ermit Application Fax 813-78G-0021
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<br /> Build�ng Department
<br /> DaEe Rece[usd .. / ` x; , - - �i � .
<br /> fc� Z �� " �� �Atians`Contai�'fbr`Permittin'y':
<br /> Owoer's Name � t''I�� -. t�wner.Phone Number �/J.��� �,�J'T��a. � :
<br /> Ow►aer'sAddra�� O�U � �'11 �'"L'-:�.� �1 Gwner-PhoneAiumber � S�J�- ��� �7-�d' !, �i
<br /> Fee 81m le 7ltlehalder"Name � ` ' � ti �-.
<br /> p cSl�� Ownee Phone 6Number l` �
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<br /> Fe��irnple Tltlehalder Addre��. , S '�"'r' ` f • °
<br /> JOB ADDR�SS � ���"'OJ , E.J�-�l�f�/� (:f/ . , LOT# � -
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<br /> ' SUBDIVI310N � .'. , -;:%��. ,PARCEk�'ID#' '"Z�`"�!"t����-AlS��3�'"��2%d'
<br /> � , , ' -• - _- �' �''.`{08TiUNEDFRQlkkPRdP.�RTXTAXNOTICE} �
<br /> , WORKPROPOSED '�'"' IVEWCONSTR � ` AD�D!/11:T � �SIGN '[� Q��. DEMOLISH ' .,
<br /> , . � :,,� �'� .:« INSTAI;L 8:.:-:_, :REPAIR' . � - ' , �
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<br /> - Q�� ' SFR- " '' � M1 COMM�, � ,....,. — -
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<br /> PR l�OSED>t3SE
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<br /> TYPE OF CONSTRUCTION-:' -Q: „`BLOCK�'�`�Q_�� � FRAME. � STEEC .[-�] �. � .
<br /> DESCRIP710N'OF YVORK + ` ��! 1��" ��' `r� �`!�1'. �lUDOd T�lUDCd�6�f�1'.,�'If/�f�s✓L'E- (�%�� l �"'?l�,
<br /> � BtJIL�t�iG SIZE"�' . ��SQ.FO,OTAG� /.�. �. �>,,,.` � _ ,HEIGHT���r ,�,- . ` � - '
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<br /> 08UILDiNt� $ �.�;�uv.. ���-'���w,,.__. .. �� l�c�C/� � . � .
<br /> VALUATION OF`'TOTAL CONSTRUCTION �
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<br /> QEl.ECTRICAL $ w � � ; AMP SERt7lCE �[�' PROGEW�$S ENERGY [�. W.R.E.C.
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<br /> QPI:UMBING � � �, Y ..
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<br /> QMECHRNIGA� �` $ ' ` ;, , �VAE.tlAT1C4N,OF MECHANlGA�ENSTA�tAT10N {� - �
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<br /> QGAS _ __Q, ROOFING_�;Q SP.ECI�0.LTY=C,� . -03HER ���L°� ` -
<br /> , FINISHED FLOOR ELEVATIONS � � FLOOD ZONE AREA �]YES. NO - �
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<br /> � B!lIk.DEit COMPANY . . J ' .
<br /> , SIGPIATUPZ� R6QISTERED Y/ N. FeE CuwtEn` '„, :Y/.N ��� , . _ .
<br /> �� �ddre�s : ` ` . + - 'Llcense#`( ��
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<br /> EtECTRtCtAhl�� • � - ' ` , �'` CCiIYtFAt�Y` =""�` .' . �� . "':_ - - ;_ - '
<br /> SIGN�ITU�E y M1� REGISTERED Y/ N FEE CURREK ".X/N. �
<br /> Addre�s ' ' *; . , . � , .t „ _-.Ltcense:#_� . � N�
<br /> P�U�fIBER �. , ' . COMP.ANY; " f - �, _ �. �
<br /> SIGNATURE � � - _, ;REI313TEREp'� �w:,.;;.;Y/.•.N�:�: .. FEE�CUwzen; ' ;Y/;N.'`;-
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<br /> SIGIV�TURE ' � .` .#�' , - _ - REC3ISTERED:; ;�Y:/,�iV.- �; ��.CURttEn P �Y:/�•N:- � ' - = �
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<br /> SIONl4'iURE;� •r=` J . . , 'REGIS7ERED. YI.N-.�::- �FE�:CURREP''^ :Y�/,N.r.�.. , , '
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<br /> R �EN1`IA►A►.�,.r:�Aitaah'2''PtotPl'aiis;2:sels:ofwBt��tt�ln�"��F!laris��1,�"set.af,°Ene �fomiis��Ft G►=1lV�Pemti`I#:for n�w.corish�uctlon;�s . .
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<br /> ` . Ml.l.m,um?:ten:(10)iWorlc(ng;days�atter�"sutimlttaf:ilate:*:Requlred anslfe;,Cons'trucaon�Pla'n's;:Sto'rmwatek'Plans;w%'§IIt Fence,:installed,,
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<br /> -:4,`SanftaryFadllties�l�lum�ster,rSlterWorkP,ermitfor.:'sutidhrlslo�sllarge`projects?;:��'r:�� ., a;r�=� � :'. . � ' .� _ »� -. -
<br /> COti�MERCIAI. Attedi(3j`i:oinptete�`sets'8f Bu1td(ng;Plaristp`ius a L�fe Safety Page;(1}set a�Eciergy Forms.Ft-0 W Permit for new canstrue�on.
<br /> Minlmum ten(10)v+rorking days'after submlttal date. Required.onslte,.Construcdon Plans,Starmwater Plans w/Sllt Fence Installed;
<br /> Sanitary Fad[iUes.�1,dumpster..SEts,Work_Permitfor�li�netiv prbjects:,Al!commerdai:tequfrements,must=meet`comptfance ., ,. ,
<br /> �., -SIGN WERMIT Attac�i(2j:sets ofi`�ng"ine:.er.ed=f�lai��:.u:;�;,�;,e�;t`- ... .�'` -�` - ,.,�`_ � ". ' ,� _ " . ..
<br /> ••«•PRQPERT_Y,.bSURVEYr,,egulr�d,�for�ll:NE1N:.c,ons.tcuction.:_.,,. --��_.:: , � _ ,.- „ � . • `
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<br /> , Dlrectton�: . '��s.. . - .. ,.=�, ._...,� _._�.. ___... �_. _�. _._ _ •
<br /> F(Il:out applicadon completely.
<br /> <O�rner 8�Cc�rtractor�sign back,otapplica�cn,natariz�!
<br /> If over#2500,�,Notice of Coromenc�mant is rsquUod. (AIC upgradss_over 57500),.._,� ��� � -
<br /> .. F�'�«:�€i:t�;;,'�r;,:='- � ...�.... . ,._.. _ .............�.�......_.__.. _ , .
<br /> Agent(for ths'contiaotcr),cr Powef'of�pttoiney'(�Or#tie`ownerj woulit be someone writh notarized fetter ftom owner suthorizing same
<br /> 'OVER�THE:COUNTER�:.PERNIITIING==�=:;.`�(Eront:of•ApPlica�cn`On�y):~�� . ._ - .
<br /> Reroofs lf shingles �Sewers Service Upgrades:A/C.',.__ Eence�:(PIot/Survey/Faotage) --- -- , �
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<br /> p�lveways-Notover Caunter If on publlc roadways.:needs ROW�J R'� �
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