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ss�»7ao-oo2o City of Zephyrhiils Perrnit Application Fax$13-?8ti-0021
<br /> Building Department
<br /> Date Received ' Ph'one�Cantact<far`�Perinittiri ` � —
<br /> Owne�'�Mame .. . . � - . �, p ..
<br /> lC.C�' ner Phone Number '� � C�Q" Z L.•
<br /> Owner'�Address I� C ` E L- . 1_ ��$�wrner•Phone Number C�� ��.
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<br /> �ee Simpte Titlet►oldartVame� � ' ' � Owner.Phone.Number ( -
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<br /> Fes 8tmpte litlshofder�Addr�ss � '"`
<br /> JOB ARDRESS U � IZ d' l.OT# �
<br /> SUBDIVISION � %��' PARCEl:'ID#' !�" �-�v—�. --�d 1 � `�5���`�-����
<br /> �. ` �'(OBTAINED FROM PROPERTY TAX NOTICE) ��
<br /> WORK PROP,OSED ; , �� �• NEW CONSTR :•�'� '"' ADD/ALT [� SIGN " ,Q� Q`, DEMOLISH - ,
<br /> INSTALt ;8>�~. =.f2EF'AIR '
<br /> PROPOS�D-IISE. SFR ' � °COMM� � OTHEFi:- : F
<br /> TYPE OF GC1NS'CItUCT'IOIV.;�� Q °BCGiCK 4',`Q��,� �FRAME, - �� 8TEEC ;CCJ,
<br /> DESCRIP770N OF 1MORK �S� . r - ; �L�� .�� �r i r� .-A/ � lD U C
<br /> BUILDING�SIZE" . " � � �SQ.FOOTACiE��, ._ -_ Y ..;H�IGHT.`,.: ,.. � /(/ �� -
<br /> BU1LDiNG $ _,='~;.,... _..., � , , r �p�
<br /> , � VAWATION O�TOTAL-`CONSTRUCl'ION , ,, � �II �j'""_ �� . `
<br /> QELECTR1CAt $ AMP SERVICE Q' PROGRE5S ENERGY [� .R.E.C..
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<br /> [�PLUMBING �w� �( � jjp j
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<br /> QMEGNANtGA�. � $ 'VAIUATEON OF MECNANfCAL.tNSTALtATION
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<br /> QGAS Q ROOFlNG: [�] SPECiAR.TY [� OTIiER._ ` "� `
<br /> FINiSNED F�OOR El.EVATIONS FLOOD ZONE Ai2EA �YES. t�t0 � �����
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<br /> BUILDER . COMP J j)lI l, � . C-"�N t�:'
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<br /> Add ess Llcense# `
<br /> EtECTRtG1At+.1� -_ " GOMPANY � - � . • ; __ ,.
<br /> SlGNATtlRE ��"' ��ts7e�n Y! N FEE GURRE� ' ;Y/N �
<br /> Addeess - � ,- • � �` . , - `.Ucense#�:� . � Y �'�
<br /> Pl.UM�ER . . , • COMP.ANY: "' . , , . .� . -
<br /> StGNATURE;'` � .` . REGIS7ERED, ' '..Y.!�N� - • .F.'EE�CURREN ' . . `Y/N:
<br /> Address ' ' . , , ...Ucense.#�I' -' �, . ��
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<br /> iWECF1ANIGAl::�� _ �_ . . � ,,. ? -.001yPANY;;; - ;,<< .. -
<br /> SIC,NASURE > <:`y :,.- , � RE�lSTEREa. ~_Y:I N ,�E.CitRR�� Y.GiV;:.� `
<br /> Address:. .. ;. ., , - . •-, . . - . -- . � ,r Ucense#-�� :(,+ -
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<br /> O?HER • _�. _COMPANY;- � . ,. , ��.•=;...:..-_.�s:..... .. ' � ' . ,
<br /> $lC31VA'TURE- -=e' ,.°,'°r • • . ._ �,,t � � �,REGiSTEt2EQ ; �YJ IV�...� .<FEEGU12RE1�` :Y�I•,N.�:. , ' ' i
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<br /> Addraas :'��, a;t:,"�.: - �"i' � : - - ' `1lcense# '
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<br /> RESiDE1�'f'IAt:°: s�4:littacfi�2 P.,iotrPians,2�;sets.of4Buildin •'Rians;- 1 �.set'of Ene �Forms;�R-t�W?Permit`for new.,;con'�tniction;�... - � ,
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<br /> �-� .wMlntmumr. n-+14 Y ,``..;. `� `wJ'Silt Fence Ensfatted, .
<br /> te -(,,.,)�wortting,dajts;,aite�„,'s`titiiiilltaiidate:'itequlted oris�te��Gcjiisttuctiori�Plans;�Sfcmiwater Ptans, ..
<br /> .. �°Sanitary�Fed(U �1 u � � , �� _,.ry;:�v:>.,!' _�•: � . ._ - . ._
<br /> .r I:,cis�&��.�c�.tR►Pster£.SI e;VUo�;Per�rnit:for;sutidiv!'slons!large.-'praJecfs'�i•�.w:�e,�� `` _
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<br /> COMMERCIAL. Attach(3j`eor`r►pte`te`sefs"of`Bu`ilding`Plens ptus a'Lffe S�afely Page;(1)set of Energy Forms.R O-W Aermit for neW construction,
<br /> Mtelmum ten(1 Q)worktng da}r�after submittal date. Reqaired onslte,.Cans#rucHan Pians,SMrmwater.Pians w!Silt Fence instalied;., -
<br /> SanlCary._Fadlitles.&1.dumpster.:Site Work P_.ertnit;for all.new,proJects::Hll comr►tierdal:�equlrements�must�meet:comp!lance -.
<br /> � SIGNPERINIT Attacxi(2j`'setsoT`�ngl��er,sd;Pia�s�:�:�;�.r� _�, .; ; , . , , , . ,.
<br /> •:••PROP_ERT,Y SURVEY requlred for at1:NEW:consWctlari... __; � ,. _.. . , ` .
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<br /> ' °Directibns: Mss:^.R�7w < . - _ ._. . ._ .._ __ . _. _ . .
<br /> F11f aat applicatian completeiy.
<br /> Owrner$ContracMr stgn back of appitcatioo.ttotatized
<br /> If aver 52500,a�Notice of:Cammenc.�ment la requtre�l. (AIC upgrades over 57500), _�. •
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<br /> Agent(for tFie contractor)`Or:Power of Attoiney(ki�the:owner)would be someone.with:notarized letter from owner authorizing same
<br /> � :DVER THE'COUN?�RuPERMITTINti`= -=: :(Frorit�of�ApPIIcaBan�Only) � � ` �- �J � ,_ ~ .
<br /> Reraofs if shingies Sswers Servica Upgredes /1/C .Fences(PIoUSurveylFootage) . . -� - ,
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<br /> Drlvewrays-Not over Counter If on publlc roadweys..needs RtOW
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