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e�saeo-oo2o City of Zephyrhills Permit Application Fa�c 813a�o-ooz�
<br /> Building Department
<br /> - � „ � .
<br /> Date Recetved .. . � . � -Rhone Goetisat�far�Permittin :;..:.V I3 � j - ��J.3 r i � '
<br /> Owtser's Nante '� , ;' ..Cn.Q . . , Owner Phone Number " "
<br /> Owqer's Address �� � �_� ' f�� � � �Owner•Phone Number �� �,
<br /> Fee Slmple T18eholder=Name� � ' ° � QwrnerPhone Nuriiber
<br /> � - « ...�r� _ � ' ' ' � -�
<br /> Fee Slmple Titleholder/�lddress "' �° - � .
<br /> JOB ADDR�SS $ a.� o�..� ��� L07'# C�.
<br /> SUBDIVISION �` , ��. pAFtCEL ID# �a' v�.to` a.1 ` CJ�!O=n O 0 E)`-~ �GA 3 Q
<br /> - � �• . 4��(OBTAlNED'FROM'PROPERTYTAXNOTICE} ' '
<br /> WORK FROFOSEp ,. NEW CONSTR ADD/ALT �' SIGN ,[� Q�; DEMOUSH �
<br /> .. � e INSTAL•L 8:�- REPAIR . . .
<br /> PiTOPdSEDUSE. �_� SFR 'Q ,COMM�, �'� QTt=1ER.: :: .
<br /> TYPE OF CONS7I�UCTION_; 'Q` �BtOCK�' :,Q' A FRAME [� STEEL �C]� "�, f �.
<br /> DESCRIP710P1`OF WORK X , ' �S � � � ` '
<br /> . ' . , . , ..
<br /> BUILDING SiZE��`� ��86l;FOOTAG�: �3 . S , . ,HEIGHT,,��..
<br /> �]BUtIDiNG $ -;}�i:�_._._. _.:,r�� ,.--.. . .. . _ , . .
<br /> VAl.UATION"a�OTAC'CONSTRUCTION
<br /> C����T����t �� AMP SERVICE [�' PROGRESS ENERGY 'Q W.R.E.C.
<br /> QPLtJMStIVG $ � ��/"'�
<br /> .� ���. ,. �
<br /> , ,�.
<br /> [�MECHAi�lIGA� $ ' " VA�.t1ATIC1N;4F MEGHAI�EICAL tNSTALEA'TIOR! � .
<br /> Q�� � ROORING..� , SPECIALTY OTHER f�����
<br /> � � !
<br /> FINISHED FLOOR ELEVATIONS _.—� FLOOp ZONE AREA QYES. NO .���'��
<br /> 8..� � ,���. ..-- - �'�'Y�
<br /> 5 � -
<br /> BUlE.DER COMPANY �` " ' - -
<br /> SIC3NATUKtE REGISTEREQ Y/ N, FEE CURREA` �.. :Y/N.._: , , ,
<br /> Address � . ' �� - ' _ ��
<br /> 4lcense#
<br /> �CECTRICIAN=::._ �, ' Cf5MPi4NY ; � . , � .
<br /> SIGNIATURE - "' REGISTEREQ Y/ N �Cu�n ` Y/N :
<br /> /1���$$ F . .. . ... -. '����
<br /> _ • - , . �.�:�Ce�6@.#-,�
<br /> ��un�eE� � .. . caMP�►rnc� ' ` , . . ... .. ,
<br /> SIGNATURE - � <REo�S�7ERED� �t.,,::,.,Y/-�N"r. � .,FEE�CURREh, . . Y/N:- `� �
<br /> Addres� � . . . Ucense#:{ . . `�
<br /> ,..._,�:�_::. -
<br /> MEC�iAR+11ClU: : . - , ., �GOMPANY , , . . , a ,. �
<br /> SIGNA7'URE ' . � , � - REGI�S7EF3aED. , _Y-/=`'N. ,EEE'.CURREk ;Y _
<br /> . ��N'•
<br /> Addre�s�- - . -,,. ` .� ' � , . . . . : " . , � -_
<br /> . - - � , Wr�nse# ��_
<br /> OTH�R � a7-��E3�..�� " - �-.GO�RPANY ��..c���!L• , . .. ; ;. .
<br /> SIGNATURE ` �RiEGIs7EREo� _ Y/, N::; ; ;FF6 CUR�n ; ,Y
<br /> ::�,- . .
<br /> J&tdreas .�i::`�'.7`�'b:: � , `� i. �Lic�nse# �C�C -�f�s7'� �'�. .
<br /> R �i.� _ _ - :;��. .;��,.s`"�' - : n''a-'7.r-a.:..�.r.�.•.4 `z'< i�.c •�x.{r": .. _ . _ , , "..
<br /> E p N'i1�0.1.;__<Attacti;.(2);,PtokP.,laits;:(2)'sefs:cif,Bu11i�1iig.Plans (1}�set"of=Eiie'.° 'Fariri =it-0-lNsPe i-fqi� t ccnstruction� .�
<br /> �� r9Y:;; `s�: tiit,t; new;: � c
<br /> ~;;;�ryMinl,;mumr„ten;(1�O,j,uvoritingrdays;atter,";su�;�lttal'date:;��Required.onslte;-Construc'Non�plens FStormwa`te��Plans w/Sllt Fenc,e Inst'slled,
<br /> . .. •Sanitary Fes�tides&s��`s���Rsler S}te V11ork��P,emtit�qr su6divf�tqnslta�ge'projects'�;,:�',°a``��*,=�-_�-:.;;<,.• . „•. = -,- .� - = , -� - �
<br /> COMMERClAt - Attach(3)°coinpiete"sets"ofBu`11�3ng P1ans ptos a''L[fe Safetjr Page;(1}set of Et�ergy Fprms.RA�/V Permit for new conatrucflon.
<br /> Minimum ten(10)waricing day�'after submittal date. Requlred,pnsite,,,f.;onstrucdon Plans,Stormwater Plans w/Silt Fence Installed;
<br /> Sanitary Fadiitles�._1.dumpster..Stte-Work-Perntlt for•.�ii_�neitV�p'iujects':-Aii+commerclal.requirements•must meet.compSlance
<br /> StGN:PERMIT Attacti{2j"sets of'�ngi�;ii�sr!ad�'Platis��:;�^�,��:'::":�.°�. .. , . �. . � ,
<br /> "•••PROFERTY_.SURVEYrequlredw.forall NEW:cons.tcuction..: , , ., - .. �
<br /> _ r..� _ .
<br /> Directlons: ..�°-�`� . ,. ° u _ _ _. . __. . _ . .
<br /> FIII out applicadon completely.
<br /> tOwner&t�.ontractor stgn badc:of appticatton,notarizad
<br /> If over$2500,.a�Nottc�,af Commencement ta requlred. (AIC upgradss over.s7500)__ __ �.: . _ "
<br /> `r;�.,-ii��t:�:.yz;:i:'_ __ '".._. ..., . . _
<br /> . ......... ....... .., ., ._.. —._ .. . . .c
<br /> �� j,.� -. , . ,�_,
<br /> Agent(for tt[e'contraotar)'or:Poiiver'of.i�ttoriiey';{fiirtlie`owne�j"wiould be someone;with notarized tettenfrom awner autharizing same , � ;
<br /> 'QVER`THE Cf3UNTER:PERMITiING==-�--"�`(Frbnt-of�Application Oniyj� ���, , ' �
<br /> Re[oafs if shingles Sewers Servlce;Upgrades A/C Fences;;(PIoUSuryey/Foatage) , �� _. ._.. ...-:. ` .
<br /> - . ' - _ _. �: . _ ., , - - , , - t � . •° � � _ ., r ,; . - .. _ _ �, .
<br /> Drlveways-Not over Counter if an publlc roadways.:rieeds RC1W" �"` `"' � _. -__
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