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<br /> 813-780-aazo City of Zephyrhills Permit Application Fax 813-780-0021
<br /> Sultding Departrnent �
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<br /> o�e R�►Yea � ���- .1 ,(r� . � �� . 5 � , �
<br /> �Rhone ContactRfor'Rermittin` {
<br /> Owner's Name l�Q� [ � T� C3vrner Phane Number /�'". �� 7' "' T�(� �. I
<br /> Owner's Address + . tlwc�erPhone-Number �� � �
<br /> Fee Slmple Titlehalder."Name � � � ,�_ ' �� I Owner Phone Number I _ �
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<br /> Fee Slmple 7ltleholder Addresa , � �° � . . � �
<br /> JOBADDRE3S � � � LOT# ���^
<br /> SUBDIVISION � PARCEL�ID# . - ` . ' ' - ' ' � �
<br /> _ � � - � � �(08TAIHEDFROIIAPROPEEtzYTAX'NOTiGE}_ - '
<br /> WORK PROP.OSED �_ ' ° N�rnr�coNSTa :° ��` ADD/�;LT SIGN DEMOLISH� •
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<br /> . � e ... INSTAI:L .8"•.;� •:REPAIR , : _ ._ . .
<br /> I PFtOPOSED:USf Q SFR Q ., COMM ,. � `OTi1ER � :. . .
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<br /> TYPE OF�ONSTI2UCTIOIV, � BLOCK�' Q, FRAME; � ST,EEL: Q: . � �
<br />� DESCRIP710P1 OF WORK '± `p G� �j f��l "-� � �� \ � �
<br /> BUILDiNG SIZE.;-� � $,Q.FQOTAGE���. ,;HEIGHT. C���>, .
<br /> ,
<br />, .. QBUILDING $ 7�;�u:.;,. _�� :,.,_._ "_ , ,
<br /> VAL:IJATICON aF`TOTAt CONSTRUCTION'
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<br /> �ELECTftICAI $ P►MP SERVIC� ' ��[� PROGRESS ENERGY '�[�, {W.R.E.C. ,
<br /> ��'��a�. ,
<br /> [�Pi:UMBING. $'
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<br /> Q NIECHAtVIGA� $ ' -V1�t.iJAT14N.OF MEGHA4�IICAI.INSTALlA.TlON '
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<br /> QGAS Q � ROOFiNG:,,;O SPECIAIl'Y°:� , OTFIER
<br /> FINISHED F1.00R ELEVATIONS ��� FLOOD ZONE AREA C]YES. NO
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<br /> f BUiLDEit COMP�IY �
<br /> I SIGNATURE RE(31STERED Y/ N ��E CuwtEn" Y l.N _:- ,_
<br /> Addre�s �. . ' '4license# I � � I
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<br /> ELECTRICl/,1N. ,- = , �5 -,,COMPANIf " .` � �C�..C...... � � • ,_
<br /> SIGNATUPtE REGISTEREQ Y/ N FEE GURRE� .Y'/N . �
<br /> Addre�s ��Q. �. .Q.(. , ' .. 'License#=� '��:�.. ( �j,t��.• 5�1��''Zt I
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<br /> PtUMBER � � COMi�ANY=- •;`:;`, �: -: • .. ,
<br /> SIGNATUPt� • - . ,. ._ :R�c3is.r��o �,;., -=.Y/�-,N � �. ��cur�en �. � Y f N:', :
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<br /> Addresa , _ , ' . .- , .Ucense#;� - �
<br /> MECM�ltCAL� . _ .. _. . ' :.C,OMPAFiY�, . -: • .- . , • - -
<br /> SIGIVATURE - ` ", ' ' REOIS7EREC1`' „ ..Y./'N', ... ;FEE CURRE�' . ='Y:/^W��: ' -
<br /> Address' - � . ,,. , •- �� - - � , , ,.:License#�I. •: �� • � -
<br /> OTHER � _ � .f...w.,:: . - ...,. �. - �' �COiY1PANY =-,, t >..= f .
<br /> SI(3NATURE,.. ',� ; , - _- .�� - , , .,REGIS7ERED .Y/ N..: . F.E@.GURF2E� _ ..:Y:/�P1,.. r ' .
<br /> Addcess �;: � ���F j � - t.,.�; .. ,. ,. _ ,. `p L'Icen§e#�`� � �
<br /> r �.ti. _ ,,�.., � _�tt_�=,i., _ ��� ,.;;,d:._�;,:>;�= '<�';'' ... _. �
<br /> R iDENTtAL..- ttacti.2'�Pict'Pians. �,set§�.oE;Suildin �'Plans•`.�1 `set',of�Ene �Forriis;�R=0=1Nr''�Perrmi�ifi;fo:rnew:,construction;; .
<br /> � ,,... - ='�-- ,t..}._�._.. ;t�� .;., . , �. �.t.�,. . �Y �_ . ...z., ..; ., K . , E_ .. • ` ;.: ':;
<br /> ,•yMlnlmum�.ten;(�1�0.)�worlting�day,s�atte�.;siititnittal:cfate:�Requlred'`onslte;�Constni�ctlon�Plans;�Stomiwater`Plans'w/.-Slit Fenc,e in;s.talled,,
<br /> .,i.�,`. .. , _ _ .
<br /> ��Sanitary Faq�[N,es;&4�,��mpste,r,;Sitet.Vitoik�Pem;tl#:fQr:sutidivl'slonsilarge;projecks;�:'.z`���;;'`�,-: _ . _. _ _
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<br /> C01Y1�IIERGIAL Attach(3j'ccmplete seis of BulMding Pians ptus a"Life.S'tifety Page;(1)set of Energyi Fortns.R-O-W Permit for new asnstruction:
<br /> Minimum ten(10)working day�'after submittsl date. Requtred onsite,,ConsVuallon Plans,Sto�rnwater Plans w/Silt Fence Installed,
<br /> $anitary Fadllttes,�,.i�,dumpster.�Site_Work-P-erml#.far alE,new�projects:^Aii,commeralat requirements must•meet complEance
<br /> SIGN:PERMiT Attadi"(2)'sets afEng�iiii�er`,ed_Plat�s:3.,7�;��`" • ., -. , , - „ ' .. . - ' , .
<br /> ••"•PROPER7Y'SURV',EY required•for;�)I NEW:.cons.trucdon.; -- - „, � ��
<br /> 'Directlons: ._.. . � .�._ � _ _.� .. .
<br /> Fill out applicatlan completely.
<br /> Owner&Confractor sSgn.back.of appltcatla�.natarized
<br /> If'over$�500,a Nodce of Commencement la fequlresl. (AIC upgrades over S7500) r=
<br /> .. P::.:^,,<^i,�::,",:'.,_ � _.�_ __ __..., ... _ --- _.
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<br /> Agent(tor Uie cantractar)"Cr.PowerofAittoriisy{forllie ownet)woutd be someone yrith aotarizad iatter from awner autho�izing same
<br /> :OVER THE COUN'1'ER.PEI�MITTINI3�=�;, =(Fronf af•Application'Qnty)�'�:�.`,"+"_ :T���"...�. - ._ ._
<br /> Reraofs tf shingles Sewers Service Upgrades,AIC .,_ FenceA.,(Pl"oUSurvey/Faatage) -- �- -- _
<br /> . . ' _.. � �� :.;: . ��;:�= - :-, ' - _ _ . .
<br /> DNveways-Not over Counter if on pubUc.roadways.:needs ROW • ,
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