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s�s•78Q-0020 City of Zephyrhills Permit Application Fax 613-780-0021
<br /> Bullding Department
<br /> Date Recefved . -�,,"��-� ° �.�-Rhcn�Cari#act!for Permittin , � . ,
<br /> Owner's Name �� � � ��+�. C. ' Owner Phone Number ��"' ������.7.�
<br /> O�aner's 1�ddres� � � `�, � f� � z �� }^ 'J � ��QwmarPhane Namber � " �
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<br /> Fee 8lmple Tltlehi6lderName ` � ' `� Owner Phone Number ..
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<br /> Fee Simpla TltleholdeeAddress ,�. �'i �°� � ' - �
<br /> JOB ADDRESS �/���V�'4...� LOT# �,� �
<br /> SUBpiVIS10N � .. � �� - pARCEL ID#'. ' � - •
<br /> . ., ' ' �•(08TAINED FROM`PROPERiY TAX NQTICE) .
<br /> WBRK PROPOSEb � NEW CONSTR •` ADD/AI:T �� S1GN Q ` � [� ,DEMOUSH • , ,
<br /> _ e ` �INSTAl:G - 8, ..,. :REPAIR - ' ` '
<br /> PROPOSED i,13E. Q: �SFR� � COMM`, Q OTHER,; .
<br /> TYPE OF CQNSTItUCTION; ' � BLOCIC ' i FF2AME,� 3TEEl.
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<br /> DESCRIP710N`OF WORK L 4 d � �� �� K�-U � -
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<br /> BUILDING SIZE„�� � j � J� r�'tJ � :�Q FOOTAGE;��. , HEIGHT':�- �.. . j ' r ,
<br /> � .�x.�w�.;._ �,�-n... .._.
<br /> ��������`' � I CJ�� , �S 'I• VALUATION 4�CITA'L'-CONSl''Rl"1GTION � ,
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<br /> Q � AMP SERVICE �[� ' PROGiZESS ENERGY [� �W.R.E.C.
<br /> ELECTRICAL $
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<br /> QPI:UMBtAiG $ ' �fJ(7v ��j�.2.�'
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<br /> QM�CHANtG,4L $ _ VA�UAIYON,OF MECNANECAI,tNSTALCATION Gr ���y��- fY`'' '
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<br /> Qc�s , ,�,, .�oo�i�v�::-:[p s��c�a�.rY{�� o�r��R� � �
<br /> ' FINI$HED FLOOR EI.EVATIONS � ��� �" � FLOOD ZONE AREA �YES. �
<br /> NO ,
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<br /> eu«.oE� �}�,��'. � � ���Piwir �..'-d``���?�
<br /> SIGNATURE ��� RECiISTERED Y/ N. FEE CuwtE�' ,, ':Y/..N:. : � , ,
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<br /> Addre�s '"'�' ' ' Llaanse`#`( - � �
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<br /> E�ECTRtClAN�,.,._; , , , " COMPANY �� - .
<br /> SIGNATURE �"` REGISTERED Y/ N �Gut�En Y/N _- "
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<br /> Address �� , �.License#�I " � ' =� � �
<br /> Pl.Uti11BER � �{ . . COMPANY+ .,. . . , _ ` . . . .. ( .
<br /> SIGMATURE . ., - '-:REG�8.7e�4. _,..;,-Y/:-�N�. � �e.cu�En, .. . :Y/,N:
<br /> Addres� � , , ,License# � -• , .��
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<br /> MECHANICAI: , � � - ; , �. � ,.GOMRqt�1Y- , .� ._ . .. �. = -
<br /> SIGNATURE � �` ReGisreri��: .:Y;/•N:.-, �:�e CUR�t� , y/-N',.:-
<br /> � Addre�s�'• - � s: . . .w ,. - .:� . . , - _ , ., -, . , ,,License# I :- ,•. �.r�.� �
<br /> OTHER �- � .. ._. „ . , _. .,.� . �- 'f,GQ�i1PANY . . � ,. ' ` . .,,. . ,- t -
<br /> SIGNATUR� = ' �- : - � . 'F - .REGIS7ERED.. . Y/. N•:` , FEE CURRE�' _ Y I.N=
<br /> �#dress �- .s .,*a;:,; ._ � .. a . . . - _. _�:License#�•�� � .
<br /> . . .:�' r�i=�^-'n'x '�';„. •' 1�u •Y:{7'V..., ' . .- , .
<br /> t' "s'1` � (; . f. 'r�".-_ .......,i�, '"""�:" �'y�i:t �'ti:'...-
<br /> - RESIDENTIAi:;�._:T=Attacti;(2}:;P1ot�P.,lans,�(2}�sets>at�But�cling�Elan`s;�(1}`set`of°Energyi�Fariitis:'.R=O=W�f?errriilfornew'.constructton,.. .- -
<br /> M;,�Minimum�.ten3(�10,J�worlting�;days:�atte'r;�"soti�nlftal�tlafe:�Requlr.ed onsite;ConsUiicBon�P.lans;�Storinwate�'Plansw/'.Sllt Fence tnstalled,.
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<br /> • Sanlfary Fac}It�es;'&�'��dumFster;-Slfe=tiNorlc�Perni1C;(or..,siitidtvl'stqnstlarge proJects'•t.��,'�;=,U:;:::'°: . . � _ ,_. ' , . . .
<br /> COWfiVtERCiAL Attach{3)�i�iitipiete'sets of"Bvltdirig`Plans plas a life Safety Page;{i)set of Energy Farrns.R-t}-W Permit for new►canstructlan.
<br /> fUlinimum ten(10)working days'after submlttsl date. Requlred onslte,.ConstrucUon Plans,Stortnwater Plans w/Silt Fence installed,
<br /> Sanitary Fac3titles�8�.1 adumpster._SltsrWork_Perml;.tqr ali-new prciject's;�Ai!'commerclai.cequlrements must meet c�mpSiance
<br /> SIGN.PERMtT A#acti(2)�set§of"Engineer;edfPlai��;;�,•�:�r�;='.: ... . -. ` , � - � , _ , , .
<br /> •`""PROPERTY SURVEY required;furall NEW.consUuc�oii::.. "- "� , . ,
<br /> � D'irectlons: ..,., � :?," , �: � � � . .
<br /> Fill out appl(caUan completely.
<br /> Owner&Contraotor stgn back.of appllcaiton,natar�zet4
<br /> If'aver�2500,a Notice�af.Commencement is required. (AIC upgrades over 57500)__. __ , � _.
<br /> �i "F,:��fi�ir'J��'::'f^. . :..., . ""... .
<br /> Agent(far tti'e ccintractor)'or:F'ower'of Attomsy(for�#tie�ownerj wp�ld:be�someone with notarized letter,from ownar authorizing same
<br /> 'D,.V,ER'TiiECOUNTER:P.ERMITTING�='".-�%(Front:of�ApPlicationOnly)��- J ' ., ^.� . � J , _
<br /> Reroafs If shingles Sewers . Service Upgrades'A/C Fences,�Plot/$urvey/Footage) w- ---� , ,
<br /> a:."'. ,,i.'f^.:.. . , , .. _
<br /> Drivewraya-Not aver Counter if an•public roadrnnays.'.needs,ROW, ,_ . �---� �� ~• -� - �
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