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813-78Q-oo2o City of Z�phyri�ills Permit Application Fa�t 813-780-0021
<br /> ,�. ,� Building Department
<br /> Qate Received .. � _ ' - ° '
<br /> '�`Phcaer.Con#ac��for:��ee�tnittin ;:',' -
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<br /> Owner'sName � ! 1�Q ��h P�Qt�t UwnerPhoneNumber � .
<br /> Owrner's Address :7 � � lD� �TI PC' ' CDwnerPhone-Numbsr � �
<br /> Fee Slmple�Titleholder�Name �� � '� Ownee Phone Mumbe'r l . � ..
<br /> : . .. , .�T� ., . . .. . , .. �
<br /> Fee Simple Tltlehplder.Addresa Y �' ''�' � • -
<br /> JOB ADDRESS ' , P .- . , LOT#_ C�. .
<br /> SUBDIVISION � 3`'� PARCEL�ID#' , • , . � �
<br /> , . ` � - '(OflTAINED�fRQM'PROPERTYTAXNOTICE� �
<br /> WORK PROP08ED ' NEW CONSTR °f` ADD/ALT •[�] S1GN `[� Q`; DEN101:iSli �
<br /> . � . � � t,f INSTALt 8'�'', 'REPAIR � ` -
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<br /> PROPOSECf�iI3E ; Q'�_ SFR ` � 'GOMNI'.. C� O�F1EFt ; .. � .
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<br /> TYPE OF CONSTRUCTIONl; �]' `BLOCK�'_ `�] ' .`FRAME � STEEL Q. , � -
<br /> DESCRIPTIONOFVYORK La ~ �Q�'5�rvi�, .� a�� �rn ' -
<br /> BU{L�16VG°BiZE�:� ��SQ;�'OOTAGE��, _ :=HEIGHT<.�..,. �� -- �
<br /> ��w. ,.. .,, .. .. . .
<br /> 081111DING $ -zz�:�:�,Y�,_ _�ar;-, �::__.-. . = • �
<br /> , . VALUATION"OF�'TC'ITAL`GQNS'I'Rl/CTION
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<br /> �E1.ECTR{CAi. $ .. �Q h� �y� - " :AMP SER17iGE Q PROCsR�SS ENERGY [�. W.R.E.C,
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<br /> QPi:UMB1i�G �$� � � �-f� ��f}U �x-vr� - I
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<br /> QMECHANlG,RI $' ' ' VAl.Ui4T14N;QE.MEGFfANIGA�[NSTALERTION C 1��`` i
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<br /> Qc►�,s � ROQFtNG,,.0 SPECIALTII � o-r���� -� .
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES. NO ,
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<br /> Btltt�DER COM�AFIY _ � ' �
<br /> S1�3PIATUI2E RECiISTERED Y/ fV Fee Cu��'`,,_ ":Y/.N,._- _
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<br /> Addre�s - ., • ., l:lcense# � � � ��
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<br /> SIGNATURE �'�����GC���� �-'" REGISTERED Y/ N + �CUR�� � Y./N� ,
<br /> Addres� � � . , , � , � _ - '.License:#��F[�Od b'a"�,�'�D ry �.�
<br /> P�UMB�R COMPANY� :; - -�
<br /> SIGNATURE " � '� �RE131S.TEREq �':Y�/;�.N'' . "� FEE,CURRFJ��� �`-Y/N:-'- `�
<br /> Addre�s ,.- . V - , � . -_ ,, Llcense#f� ' . ' � ����- �I
<br /> MECHANICAt:� _ - .^. . , _ , , ,Y , �� :CqMRIyNY.. _ ,. = , :" , .,�,��''•: , ,,: : -
<br /> SIQNATURE ' ' �� � " � REGIS7ERED� „ .Y;/.N- .;��FEE CURRE�` ' Y/:N`,., � ' `
<br /> �lddress� .- , . `. ,.z.,. . , � ..{. . - , . . , , ' ' ` _Licsnse.#=� 5 - F���," +
<br /> OTHER - , . �,, 41ti . ,. :. - � , . ` �,:.GO�I(PANY. '�.,,� .. __, .. • .� - . ., : � ' .. �
<br /> SICaNATURE.~ .. ;,_ , : , :'F `, . . " �.REGISTEREp.r , Y,l N�_..� °��GURt3E�=., ,YJ�N�,.,
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<br /> R�SIdENTiAl:,`s���Attac.ri;`2�:P.,lof:Plans�,2 :sets.of�Buit�in"Plans;.�1�setaf�Ene��"y�Fariiis:`R nevir';co n;:
<br /> .4.�... � ,t. }�� ._ ,,{.), .: . .... �9... {.,)�„ t'9 "=o=vit°£ : - ` c�fo -
<br /> �_ . � ._.,... .- .- . ..,�. , ..: . . . r_,,,,.,a..: .�.rmlt far ,ns„tru;:�..-
<br /> �Mini um;.ten�(:1q,sw,,orking yi,s = = eq � F°„ ,>, ..� �..
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<br /> •..,1;y ,,,,T; ,�,.)w ;da ,�after,',"sutiLiiittal'ilate::.R``�uired onslte-Const'rucdon,plans;�Stoimwater.Plans wl Sllf Fenc,e installed, ;
<br /> � '�. Sanitary:Fac��ttt�s;8�;'��;�{ui�ipste'r,':SIte�Vllork�Per.rr�it:�or�sutidf+ii'sliinsllargerpiojecws�,;:>`�.�.�3,: .. :. . , � - . - `- -
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<br /> CO�II�tERCtAt Attach(3j�eoinplete'`sefs of Bultding Plans ptus a L1fe Safeiy P,age;(1)set af Energy Forms.R O-W Perm4t far nev�i coristructton.
<br /> Mlnimum ten(10)wo�lcing days'after submlttal date. Required onsite,,,�;onstrua8on Plans,Stormwater Plans w/Sllt Fence installed,
<br /> Senttary Facltitles��:1.dum�ster..S1fe.Work.Permlt�tcr aitTMnew"prisjects;Afi commercial:requirerr►ents-mustmeeYcamp!lance , ,
<br /> SiGN:�ERMiT Attacti(2)sets of`�ngineered�.Pl�i(�s::�a;�*�,�_��-_, . •- , , ' �
<br /> •'""PROPER'TYSURVEY:required:forajl-NEW�construcGon:. -_ - - - � , - � -
<br /> Diiecti`ona: .,"=�-r._�F.� _. ,.. __ _ _ �-_ -_ _ ...__
<br /> �`FIII out appUcadan completely.
<br /> Owner&Conttactor stgn back;of appilcatEot�,notarized
<br /> tf'over�2500,;a;Notice af.Commencement is requlred�,(AIC upgrades over 57500j__ _ r , . -
<br /> .. ,.,:�:'x�;°°:�'�i:��,���`.�, .. ,_ __.,......
<br /> A�ent(for ttie contrackor�ot'P'o�e'r`of Attoiney(fo�'ttie:ovmer)wou4d be someone with nota�ized letter from owner authorizing same
<br /> 'OVER=THE COUN'I'ER:P..ERMIT7ING=`:-.::�(Frcnt-.of=Appilcation 0iily)��.�F. „� +�� -�;, 5 *
<br /> Reroofs if shingles Sewers Service Upgrades A/C � Fences;(Plot/Survey,/Footage) -Y- -
<br /> �.n-� --r_ ..�: �-:..�...r° -.... _ , ..�� '-r�;V..i�;`:�.^-_�;���:' _ - , � „ ,_. : _ . , -
<br /> Driveways-Not over Caunter if an pubtic roadwey's"::neiads ROW � �
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