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s��aeo-ao2o City of Zephyrhills Perm6t Application Fax 813-78p-0021
<br /> � d ' ' Buitding Dapertment
<br /> Date Receiv�d t = . � . '� �t.-
<br /> � -'' �J � Y �: �Phone�Conta�#<forPermittin `;: " o�G
<br /> Own�r'�Fiame � I�� �s�} t} . Owner Phone Plumber l-�.` t ��tJ�,S��c .
<br /> Owner's Atidres� ��s� L:' �1�°L- D t {J t9wnsrPhone Numtier ' � � �.
<br /> Fee Simple Tltleholder;Nama• •� � ' �� Owner Phcni Number r-,, _ �
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<br /> Fee Simple T(tleholilerAd'dress � - �n' � - �
<br /> JOB�►DDItESS . , ' ' L07#_ ��
<br /> SUBDIVISION �� - � , PARCEL'ID�"' I ('Z Y�."'-'�i('"'�v�0^(/a ZC�G�'`.."-G70�(,�
<br /> ' . ' ` � {48TAINE��FIt01NPROt+ERTYTAXNOTiCEj" - -
<br /> WORK PROPOSED . NEW GONSTR `� �` ADD/ALT Q SIGN Q � ,;'� `�';' �.ti rDEM4GSH •
<br /> `�H lNS7'AI;L� ,e �� •REPAIR � . z
<br /> PROPOSEQ�USE. ' Q'� SFR [� COMM'`; � OTHER; '.'. . _ �
<br /> _ . �, .. . . . :
<br /> TYPE OF CONSTRUCTIOIN.^ ., Q 'BLOCK','Q', � FRAME, � j.STEEL Q. .-,
<br /> D�SCRIP710N�'OP WORK A' ' / • r '
<br /> BUILDIN(3;SIZE'�� '' $Q,FQOTAGE�� ,; :-,�� �HEIGHT:��, � `
<br /> QBUILDING � .�_::�,,,.�:.:.. . ..�_.. , , ,
<br /> VAL>UATION"a�TOTAL�CONSTRUCTIQN'
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<br /> QEi,ECTRICAL $+f,,;,,.,� �AMp SERViCE Q PROGRE$S ENERGY [��� �W.R.E.C. _
<br /> QPL•UMBiPfG $` - �
<br /> ` � � , � , ( `5�
<br /> QMECHANIGRC � $ ' ; . VAi.UATlON:OF..MECNAI�IGAL;INS'i'ALLATtON -�t �
<br /> QGAS [�.. ROOFING.,;,� SPECiALTY•� �TMER- '
<br /> FIMSHED FLOOR ELEVATIONS �� FLOOC1tZONE AREA QYE$. _ NO ,
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<br /> BU14DE� GONOPAIdY " � •
<br /> SIGM�►TU�tE R�GiSrE�D , Y/ N ' ��Cuw�En' ,., YJ.N.:- ,
<br /> Addre�s , "�, . :4lcense#'i . � �
<br /> ELECTRICiAPI- ; • ,,;,j.�/�/,����-��*✓ " ' .'+CCIMPANY - .
<br /> SIGN�►TURE C x � � �' REGISTERED Y/ N FFE GURRE� 'Y/N " �
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<br /> Addre$s . � � . � , <� ,�icense#��'' - �
<br /> PWMBER � . , � C,OMPANY- , ., - .. .
<br /> SICaNATUR� '� ' ' �� - . :REG�S7EItE0 ,.- �?�.�-:��rY•/��N �• F,EE:CURRe�'' . _ 'Y/�N.
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<br /> Addre�s „. , . . , .IJcense#�I� ._,. � _ - - �w�
<br /> RAECHA►NiGAi:" ' .. ., ,_ � _ . ' ' , ,CQMPAFfY:: + - k � - _ - ` __ . .
<br /> SIQ�WIATUI�'� . . , ` � ' 6EOISTERED"' :.Yr/''N:�- �:FEE`CURREQ , ��Y�-:r.
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<br /> Addres$- � - - -, ,:;� ,. ,�� ..� . , .. d .. - - ,r ,.�:Licens,e# �._,_.��
<br /> OTMER , _.s. ..- , _ ._ �,� - - " ',.COIIAI?ANYk ; � . . :: ,. . . . ,_. ._.. , _ .
<br /> SIGPIAYURE, `s= . - ;`;'; • . . . • � �REGISTERED. .� Y/..N,::� F.E�CURREA; _iY:1cN�:� . , -
<br /> Addre�^, .h.�a ��, - `:� � :it_,�^ • - s.,�;: `r,. - .. >„ .. . - '~ : � .�,� . �.
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<br /> � viit ` .n.'.5��. F y " . LX::''''-",=.4t<.- ...
<br /> R6SID'EiVT1�1L:>,} .A,tkacFi;,2;�?tot;•Plans.2:sefs�ofxBulldtn'�'�filans•`�1=�setiof�Ene~ *Forrn's�'R=t�N►,Rerrri'ttfortnewconstnicUon•�.
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<br /> �'�t,Miriimum{:tens�tq, oritin d"a. s-a r` � '. k Q c�installed,
<br /> .: v,.,,,_...,� �,.�.���k;.. ;9:,. Y..�,�'$ubinittal�clate:==Requlred'onsite'rT�'ohstiticdon�.Plan"s;,�Stortnwateh�Plans;w%'§II F' n e.
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<br /> Santtary�adtt�es�:8�n1;.cli�mpster,S�te YKcrli:Permi�#Q^r Esu�a�v�s�or��iar�e�rojecas�: h�..,'..:= �. '..:.�.� ` ', -' �j= '.�` ,'. . = . " -�--
<br /> COMMERCIAL Attach(3j compiete'"sets"of Buli�itng Ptans pius a�L`�fe Safety Page;(1)set of Energy Fonms.R-0 W Permit for new canstni�tton:
<br /> Minimum ten(1p)workfng daye after submlttal date. Required on,site,.ronsVuodon Plans,Stormwater Plans w/Silt Fence Installed;t,
<br /> Sanitary Fad11t1es:�.l�dum�tster:.,Site Work-Permlt.for ail new'projecfs':All ccmmerclaG cequirements musfi mee#�campilance
<br /> �SIGN:PEItM11Y AttacFi'2 sets`of�En1"'ee�ed.F+lai;is;;�;;.:r,:�::':.,'r.•, . . , .,r ,., .,.. .
<br /> � )� 9<l�,. i;. ,' '.:,
<br /> "•"PRQ(?ERT:Y..SURYEY reguired;for,all�NEW�ccnsWCtlon., � - , � ..
<br /> Dl�eetlon�: .:,:�, .. ,_ _ - _.- -• - .
<br /> Flll.out eppNcaUcn completely.
<br /> Owr�er&Con#ractor s�gn back�afiappSicatlon,natarizad
<br /> If over�62500,��.Notice of Cammenaement Is requlred. (WC upgrad�s over$7500).,,_ :: �� . -, -
<br /> N ''�ry:w'ei"-li`��:"i7*i�F:'-.. •' '.. .aM. , ,_
<br /> Agent'(far tf�ie coatsactpr)`o�:Power of Attoiney{for!ha'ownerj wauli!'be someone-with notarized tetter from awner autho�ztngsame-4 .= .. .
<br /> OiLER�THE COUNTkR.PERNiITTING--==��.:�(FiooQofllApPUoaBon Only)� .� ,. , ._, �
<br /> Reroofs lf shingles Sewers Service Upgrades A/C Fences(Plot/Suryey/Faota9e) - : - - ,. � , -
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<br /> �rivaways-Nat over Counter if on public roadways.:needs ROW " ` '� -- •--- .� _ „y'
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