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a�a-780-aazo Ci#y of Zephyrhills Permit Application Fax-813-7$0-0021
<br /> y Bullding Department
<br /> Qats Recelvsd ,,:.- �._ , -
<br /> Phaee�C6eitac#�for:Psrmiftln
<br /> �O�rrer's�Nairce . �: G Q• � , �—� ���T� Chw�er Phone Namber ���S -���
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<br /> �nar'a:Ad"dress 1(�� QrC�� � Owneri�hone Numbsr
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<br /> Fee Simple Tltleholde�:Name�� � `� Owner phone,Num6er ,.
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<br />', Fee Simple Tltleholder.Addres� L - ' "
<br /> J�'08'�/yDDRES�. .�� �O R,.i..f !J ~ LOT# ��,,,��
<br />` SUBDIVISION I � � P/4RCEL ID# ' = ' ` ` - ' , . �
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<br /> ' �(OBTAINED FROM`PRdPERTY fiAX NOTICE)
<br />( WORK PROPOSEp �� NEw CONSTR �.' ADD/A1:T � S1GN �Q � "Q}_ DEMOLiSN �
<br /> ,. s.�,.• ` INSTAI:L �8'��� -'-REPdIR' .
<br />� PROPOSED:USE� Q SFFt � ,COMM'�` � � �OTl1ER -
<br /> TYPE OF CQNSTRUCTION; '`Q`' ;'BLOCK•'�;'Q; �; FRAME �'� :STE�L Q .. -
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<br />��DESCRIP�T10Pf�OF�WORK '` (/l P C��'�¢ (1 � l�"r' .l;,�d �dl•U.�U� � UV ��
<br /> Bt71L�tNG SiZE� � ` �•�: s . $ , - • - ~ - .
<br /> SQ:FOQTAGE... �HEIGHT .
<br /> �`:-.�BU1�' � 1 b� �_`'==,...�� � �. ;
<br /> �;�� , ,VAI:UATIOiV�F'�TCl1'AL`GONSTRUCTION
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<br /> QEl.ECTRiCAI � � AMP SERVICE Q PROGRESS ENERGY C] :W.R,E.C. _
<br /> QA1:UM61NG $ } .
<br /> .� �C.`�� � . . . - ?�^����= ,
<br /> �MECHANlGAL $ `VAt,.UA7'E{.1N,OF MECHANICAL,INSTAl:tATtt?N � I :���L / �j1
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<br /> QcAs 0 � �aoF��v�:i}p s�Eci,a��r.�- os�ER � 3/
<br /> FINISHED FL,OOR 6LEVATIONS FLOOD ZONE AREA �YES. NO �/ � �;
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<br /> �BUit:D�•ER�..;�:. (� i ' (p��� CQMPANY' � , . �:YJ!U✓�1�it�'"
<br /> SIGNATUREf<: 1 ��'d'� RECiISTEREp Y/ N. �e 4uw�en, Y/.N_< .
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<br /> Addre��s .' " l:icense�# I �' . �
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<br /> �EtECTREClAH. :; ,. - ;, �"' COMPANY .`' ° � . #` . ' .' '� .
<br /> SIGNATURE �' REGISTERED Y/ N F�cuttit�n `.Y`/N .
<br /> Address , `.l:icense;#'p �• �' - e � I
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<br /> PlUi1�8ER . � r . . . CQMF�ANY.> :�'� , '; . , ?. . ,• -
<br /> SIGNATUR��. � , . �REGIS7EREp• • =�Y/�.N � .FEe.Cuwt�n�; u -Y/"N: ' .
<br /> Address � .� . , � , ..Ucense#�� , �
<br /> MECMANIGAi:; �`' ... - _ .. , ., � ` . .COMPANYr. ,::� ��:: r�. :�.; :,. ... ,,.y:,. _ � �
<br /> 81GNATURE ` "` . , .� . � � , . , RE01,$7ERED��. Y./ N., r��E�Cutt�n ��Y'/�iV<.;, ' �
<br /> Addrea«;. , , . �� -� ._ . ,,; . . - .- _- . , _ . ... ..:L(cense#-� ._ , . •I ,
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<br /> O'tHER " - , , . ;' "' ." . .,. Ci�lylPANk' -
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<br /> SI(3NATURE.r , . ' � ` ` , .`.` ,_ � � , `REGIS7ERED , Y/. N:-.;' �FE�,�URi;En Y,G,N._ . , . . ,
<br /> /�dP98S~.� �,r�` WraK a,:-, . ....�:��d.:�.:.i<.:..'__ , ,s:""', h .�... ' ,.. `"�C�flS6�#'� ' .. �
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<br /> �RESlDEi�T{AL.._ ,...,.. ,,,Z , .. � ;:. � h ` �En _ .- ���'::.. �#�_-�,
<br /> .. 'Attach�(2};p1ot;Plans,x(,};`sets=of. ulldl'n'gkFian`s,.(i.}�seY'of� ergy��oiins��R=O=W�Pemnl#:for,6 �constrv�fionr;
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<br /> ' �rMinlmumkten;(�1rq)�wo,rking days�a_fte�„sutiriilttal�ilate Requireii onsite G�anstiucHon�Plans;yStormwater.Rlan,s w%Sflt Fenqe(nstalied,
<br /> . �Sariltary�'F.,acil4tl�s;&�1Dslu�n�,s_ter,Sl�Work�Per;rnEt#or�;stitidivlst0ii�ltarge�projecls':��;:`.��.w�f:`-`-� . .. � __ .. - - _�. .
<br /> COMMERCtAi. Attac�(8j`eomptete"sets�of�Bu"Itdirig`Pl'ans pius a Life Safety Page;(ij set af Energy Forrns.R 0-W Permit for new canstruc#an.
<br /> Mlnimum ten(10),working days aRer submittal date. Requfred onsite,uConsWctlon Plans,Stomnwater Plans w!Slit Fence Installad;, .
<br /> 3anitary�adlitles&1y.dum�tster..SiteAWork,Permtt,for�Il�newtpri6jeoEs:AH"commerciai.requtrements must meet_campilance . .
<br /> StGN'PERMIT Attacti(2)sets of'�ng'�jieer�d<Piait�s,i� �'ri��- { .' - ._ - ' �
<br /> `•"'PROp.,ERT_Y,.SURVEY-reguired,For,�aJI,NEW;construction.;, , - � " - - _ .- -
<br /> D(r'ectlons: .W_.:����',�. .. _ __ _ _-� _ _ • .
<br /> Fill;out applicaNan campletely.
<br /> CJwner&Contractar sign.back•of appt[cattan,notartzed
<br /> If'over$2500,a;�Notice of.;CommencQment is requlred. (AIC upgrades_over,S7500) s �
<br /> �� t:;6::7i,;y�-a,a�,.;.gx�.:.Y.,.�.:..„..a:,..,..__., .-.,_.._»..............._.— — . . - `
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<br /> Agent(for ttie contractor}qr:Power of-Attortiey(for fhe.owr►er)would'ba someone.with,notacized letter from ovmer autho�izing same
<br /> .aVERTHECOUNt�,R:P.ERMilTiN�G�=�.=�--:`(Front�of�Appilca�on�Only)-� , . .` .,U,, . - r- - _._.. .
<br /> Reroofs if shingles Sewers Service Upgrades A/G Fences(Plot/Survey/Foatage) _ �- �•- -
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<br /> Driveways-Not over Caunter if an publlc roadweys.:needs ROW
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