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<br /> 813-780-0020 City of Zephyrhills Permit Application Fax 813-]
<br /> Building Departrnent
<br /> /�ate Recelved - ` . . . . . � _ � �
<br /> Phone�Contactzfor"Permittin�", ' ��� �: :i
<br /> Owner's Name �o��D R" ��C R�L �.�-�N.l �. Owrner Phon�Number �13' �$O� �1�l. �
<br /> Owner's Address ��S l�j M A2.IC�T . �A � Owner-Phone Number
<br /> Fee Simple Titleholder'Name=� �'�'� � � Ownec Phone Number� -_
<br /> _ ' _ , �if' � . ' . ' . . . ..
<br /> Fee Stmple Tltleholder l�ddress °' °r, - � , •
<br /> JOBADDRESS ��I � MA�Q,I(,E� v�(?f- Z'�{L�.LS �L33��— LOT# �
<br /> SUBDIVISION - � PARCEL`ID# ' - _ -, �� _ , .
<br /> � � � "'(OBTAINED FROM PROPER7Y TAX NOTICE) -
<br /> WORK PROPOSED ': NEW CONSTR •• � ADD/ALT Q SIGN�" [� ` Q�, DEMOLISH
<br /> .. - - BI•. ' INSTALL .REPAIR' , `
<br /> PROPOSED°-USB.. SFR �COMM'` � OTHER " � �
<br /> TYPE OF CON8TRUCTION, ' BLOCK�' 'Q�` �� FRAAAE 'Q STEBL. � Q. -
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<br /> DESCRIPTIONOFWORK � IM�• EN��AT�D(✓ I-o(L Mf�IC�4( oFEI.L� Sl"�C� w tK�,�'..� , ,� ���
<br /> �UILDING�SIZE ' 4— (S i;,�� t$Q.FOOTAGE �'�s1 � � . . �
<br /> ;-�: , , ,.HEIGFiT•. l �C.��_�o
<br /> QBUILDING $ ' : VALUATION�'a�bTAL''"CONSl'RtJCTION " � �
<br /> . . � �oc� . � � - - ,
<br /> QELECTRIC�IL $ � AMP SERVICE ' Q ` PROGRESS ENER� [� W.R,E.C. ; !
<br />� QPLUMBING $ . J'� ,
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<br /> [�MECHANICAL $ � 'VALUi�TION OF..MECHANICAL.INSTALLATION r � � ,
<br /> .� .- �S ��
<br /> 0�►S Q, • ROOFING:+�Q SP,ECIALTY �-- OTHER ��
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES. NO `-'" '� �'/"�\/I
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<br /> BUILDER � � 1 �A r , :� n •_ � �. r J �-C�
<br /> COMPANY . ,-.,_.,: . .._�
<br />, SIGNATURE REGISTERED Y N. �e CuttR�n' , Y l.N. ,:
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<br />, �dres$ 5`�3S' h-�..� l���b-s� �No r,1� sT �-rc,. ,c, .3 _ - �
<br /> � F 3�,7� ��cense# Z(�6(ct�l
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<br />' ELECTRICIAN -• : - ��J PANY .. - � . � -
<br />, � SIGN�ITURE Cc/li� REGISTERED Y/ N FEE CURREk Y'/N� ' �
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<br /> Address -- .
<br /> � '�Ucense#>, �
<br /> �`L' PLUNIBER ' ,� COM ,. , .. . �
<br /> snx SIGNATURE ` ' ����� �,��G " � , � , "
<br /> 02�, REGIS�TERED; . . -:,Y,/�N''' , �FEE:CURREP�� 'Y/N: �'�� �
<br /> R'I° 780�002� _ "
<br /> �9(3-�ddress ,, . � � � ..Ucense# , ' I
<br /> MECH�NICAL .. ��p ' -_ _ -.0-OM�A�If' ��`�'� -����°'��� �=i �..3 nv+�-o
<br /> SIGNATURE �%' "' � "' •
<br /> �l z � , REOIS7ERED: .,:.:/.N: ,::FEE CURRE� ' Y-:/�►V:+,� • '
<br />� s2 ddfesS� . .. . _ , .,_ ` ,., ._ " _ , , LICenSB#- , . ,
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<br /> OTHER :�; . ,:_ . . .. . _
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<br /> SI(3PIATURE���`'`�: ,:_ ', .,,.. _. '' . ... C GqAPANX,,. _ _ _
<br /> R � , „ Y/.N: :FE6�urt��-„ Y�/.N� .
<br /> Address ' ,= _ ... �y` .. . _ -. " . , d,- ' _ . < `License#• - � , . �
<br /> RE�IDEWTIAL�:. �:q ��; - _ _.:�.�=•�. 4;�.� ..:,4:;;G• _ ,x��,�=, �;� .��:s� ;A:4�;� .,.,:. . ... - _ -,
<br /> ,.., tta .(2);,Plot;,P,lans;�(2);set's,`=of,Bulltlin Plans;, 1�.�set;of`Energy�Forms•�R=O=W�Permi � � - .
<br /> ,9':. �-)`'�. �,;.:�.ry._ . ,t:for neuy';con�,truClion; .
<br /> n;Mlnlmurti�.ten'�(+10)}w.orlting�;days�a(ter„sutiriilttaliiiate:r!Requlted onslte;qConsUucdon�Plaris;�Stormuvater'Flans:w/Sllt Fence Insfalled, .
<br /> ���SaMtary FedlltlQs,&f1�,dumQster,,SlteyWoricw�Per.rnit'for:sutitli�lslOns%lapg`e;projects�%:_�:;;;Le;�"':':`''��: -� � . ` � � � � �
<br /> CONIWIEE2CIaL Attach(3j csomplete"sefs'of Bulldirig Plans plus a-Ufe Safety Page;(1)set of Energy Fortns.R-0=W Permlt�for neW constructlon.
<br /> ` Mlnimum te�(90)working days'�fter submlttaLdate. Requtred onslte,,Constructlon Plans,Stormwater Plans w!Sllt Fence Installed; -
<br /> - Sanitary,Fadlttles.�1.dumpster.;Slte.Work.Permlt for:all�new:proJecis:'�All'commerdal:requfrements must:meet compllanca
<br /> SIGNPERMIT Attacti(2)set§ofEng;in�e�ed;Pla[�s;q:,;;:�;'��-•�:: ' • .. - ,
<br /> "'•PROPERTI!ySUR.V,,EY:requlred�fora)1_NEW;cons.tructlon.:...,,_ - - .
<br /> - •-�- ..
<br /> Dlrectlons: ,:;�•_.h:. . .. -• .--... _. . _ _. . _ . .
<br /> FIII out eppNcaUon completely.
<br />� Owner&Contractor sign back of applfcatlon,notadzed
<br /> If over 52500,a�Notice.of..Commencement ta requlresl. (I�JC upgrades over 57500)._ _ .. .
<br /> �, ...,,..... ..... ...
<br /> " Agent(for tFie ccnTVacto�)"o�-Power of Attortiey(forthe�owner)would be someone with notarized letter from owner autho�izing same
<br /> 'DVER THE COUNT�R?PERMITrINti�===""'`(Front=of<Appllaation�Arily)'���=�,��m��
<br /> Reroofs If shingles Sewers Servlce Upgrades A/C , .Fences�(Plo.t/Survey/Footage) _ _ _.__ _ .� _. _ .
<br /> _- .-�- -_ - - _. .. - - �;.,.. ; ��_<<. ;..;:;�..''„� - , .,, � . _ .... . - , ,
<br /> Drlvewrays-Not over Counter tf on publlc roadwey&::rieeds ROW �
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