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813-78�-0020 City of Zephyrhills Permit Application Fax 813-780-002�
<br /> � Building Department
<br /> Date Recbived . = � _ � �
<br /> � =� =Phoni=Contact';for:Permittin ` �
<br /> Owner'a Name �a v�� �t,5, � � j C� " � . Owner Phone Number � l'�'l S . �'�. � ,
<br /> Owner's Address �7 i�°� ` F ���/✓L n L �?S,pwn�r•Phon�•Wumber ` ,
<br /> 7 '
<br /> Fee Simple Tltleholdee=Name ' ' Owner Phone Numbee _ ..
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<br /> Fee Simple Tltleholder Addre�s . •'" -• � ' � -
<br /> JOB ADDRESS 'C� "'� Y ��C ' Q (� � LOT# �
<br /> SUBDIV1310N � PARCEL ID# ' ' '
<br /> , , , ' �• ` .-(OBT/UNED FROM PROPERTYTAX NOTICE) •
<br /> WORK PROPOSED . NEW CONSTR � � � ADD/ALT �Q SIGN � ` Q�`, DEMOUSH -
<br /> ; , B rt "INS7'ALC 8 ��� .REPAIR ' '
<br /> PROPOSED:USE. Q+� 'SFR ' � COMM�` Q OTHER`, `` -�
<br /> TYPE OF CON3TRUCTION.. �'Q `� -BLOCK�' Q� ,' FRAME Q STEEI Q� � - , � - �
<br /> DESCRIPTION OF WORK < l� t{'G -- i�lo b: � ✓1�� N �" � �'� ,,
<br /> BUILDING�SIZE;:, ` S.QFOOTAGE:�. , ,:HEIGHr:: ;..-,=� _ - , ' �
<br /> ' QBUILDING $ -�'�.�a:VI,:�..e _,.rdP.:,,.-.,.,.. • .., _ � ..
<br /> , . VAtUI�TION.O�'I'OTAL CONSTRCICTION , , „
<br /> QELECTRICAL $ AMP SERVIGE ' Q` PROGRE$S ENERGY C7 W.R.E.C.
<br /> QPLUMBING $= ' �
<br /> Y i�Y. /
<br /> [�ECHANICAL $ � ,✓ , ' 'VALU�►•1'ION�OF MECHANICAL INSTALWTION • '� ���
<br /> '�Z� � � -
<br /> QGAS . .Q � ROOFING,-s�0 SPECIALTY�Q � OTHER ' � '
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES. NO
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<br /> 'A/ / .
<br /> �UILDEFi COMPANY ` - ��'// � . I"l.S _. .
<br /> SIGNATURE REGISTERED Y/ N . FEECusrtEn` " YLN.,�, I
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<br /> Addres� . � `Ucense# �-, . ,
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<br /> ELECTRICU�N�... . �. � `.' COMPAM' � ` - , ,'
<br /> SIGPIATURE � REGISTERED Y/ N FEE GUFtRE� ` "Y'/'N :.'
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<br /> �icldr�s � , ,�.License`.#�' - - , . .
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<br /> PLU�9BER . . COMP.ANY-- �;' - _, . ._ . _ ex
<br /> SIGNATURE ' � � _�tEGiS.�REp- , w u�t:Y/-,N'-� � �FEE�.CURREN� :�>Y/N: '
<br /> Addre� .. , � . , , ...Wcense;#; � • - �
<br /> � . . . •. :F; . , .. -. .., . .
<br /> MECHANICAL,_ Y. � � '` -. � _ . ' , ,CONIPI�NY _. ` - s _. - ._ ..: , .. �
<br /> SIGNATURE ' , � . - , REGI�STERED� . , .�Y:/�N:-: ;:FEE CURREN �~Y./N;�':• . -
<br /> Address� , . - , ... _ .� _ ` ., r Wcense# �r � �.
<br /> OTHER ' ��;... , � . , = :., :. . _ ' ;.COI,APANY� �- ..s.. wa,.:;��,, -_ ... , < , ; , .. , _ - .
<br /> SIGNAYUttE. � � ` `` " `"' '� - s `�REGISTERED Y/�.N� �.�FE��GUR�n� YJ.N-,:, - . �
<br /> � , . :.: . • ,,' ti : `-.` _ ;�
<br /> Address .,. �h';,�;°,:�.,.�;,F18' .3:i:_ ::S' -G✓' /' '�tfC ,����L�'/ . `'License�#�" . . , ... -
<br /> ' . �' � ' . :3'Y•�ry` '
<br /> ' - - ' ' :.�„ .4. _ - ' nr'("..i�k,'t'�.:i'.,.,'�i.:i'' - "
<br /> '�� I�"1" lan �1�''se`_'of�Ene? ��Form"�`R-0=1N�Pe[mit for new';constructlon - . . ,
<br /> R�SIDENTIAL.; �;=°AttaoFi`,(2);Pl_okPlans,.(2);sets�of,Bu Itl ng.'P s;;(.;),._t. . rgY , s, _ � . -
<br /> ^Mlnlmums.tem�10;�wiorktn :da":atter,;submittalidaCe:��R�'"uired'onslte;-Co'ns't'nictlon�Plans��84ormwater`Plans w%�SIIt Fen.c,e,installed,
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<br /> .:, ����1 .. , _.9, .NS. _ _ . �9
<br /> .s=> - . , ,. -.��. - . : -
<br /> ,,,-�_::.: ....4..,:,,.. , W,_.
<br /> Sanitary-:Fec111tle.s;,&s;��"ur�pster,Site;�llLo� :Perm�f'�;�orisutidivislons%Ierge�pFojects'rs=:c�W�=:>,:�;' � _ - � --= --, '
<br /> COfWMERCIAL Attach(3j�c"ompiete`se's'of�Bulldfng'Plans plus a Life Safeqr Page;(1)set of Energy Forms.R-O-W Permit for new conswcUon.
<br /> Minimum ten(10)worlcing days'after submittal date. Required,onsite,,ConsUucdon Plans,Stortnwater Plans w/Sllt Fence Inst�lled;, .
<br /> Sanitary FaGlides.8 1.dumpster._SItB.Work.Perrnitfo�;all;new�piqject's:Alf;commercial:requlrements mustrmeet_compllanca .
<br /> . --� ,-.>:-�• . .. - , .
<br /> �SIGN:P�RIVIIT Attadh(2)`setsof'Engineersd;.pl'ans;•>;;-%ti:r:��-=;::s=::.� - .. ' ,
<br /> •••"PROP,ERT.Y...SURVEY�r�ayuired forall,�NEW:construcUon:_,. �- _ � _ ,. - ,
<br /> Directlona: �... . ". . . . . ,. . .. _ .. .. ._ .__� . _ �
<br /> F[It.out epplicatlon complstely.
<br /> Owner 8 Contractor sign back.of applfca8on,noNadzed ,
<br /> If'over 52500,a Notice:of..Commencement la required.r(AIC upgradea ovet i7500)__ _ �
<br /> .. t �ti;:��u`� .
<br /> Agent(for ttie contrac4or)o��P'o�iue'r.`of Attortiey`(for,tFie�owner).would be someone with nota�ized.letter from owner autho�izing same
<br /> ;OVER�THECOUN.Y.ER:PERMITrING�-�--:�(Frontof�Application�Only)` ' - � :,x�, � �
<br /> Reroofs if shingles Sewers �ervice Upgrades,AlC� Fences�(Plot/Survey,/Footage) -�•- --_�� ,_
<br /> __ _ -. - -_ - , • ,, . _ .. .. : .... .
<br /> .•.e:�;;ii;s:�r»:;�r...�=r' - ..:
<br /> Driveway3-Not over Counter if on public roadweys::needs R01iV�
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