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a�saeo-oo2o City of Zephyrhills Permit Application Fax 813-780-0021
<br /> Bullding Departrnent
<br /> Date Recelved • . 2�2 _ ��� `
<br /> � 'Phone Contact,for'•Permtttiri' l 3
<br /> Owner's Name ��1e$�� � /�� � Owner Phone Number ���� /�� ��./� �
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<br /> Owner's Address ,�/�� �� �� OwnerPhone-Numb�r
<br />'� Fee Slmple Titleholder?Name��� ' � ' Owner Phone Number '
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<br /> Fee Simple Titlaholder Address - . � •�
<br /> JO�ADDRESS ��Lp�� G j,7')') IJ� , LOT# �
<br /> SUBDIVISION ��A�N D dr/Zb�S ' . . PARCEGID# ' 3�' � o�� -Li � �� � �b�����:.7o2CJ
<br /> . " . ` � ` � �' '(OBTAINED FROlA PROPERTYTA7('NOTICE)
<br /> WORK PROPOSED . NEW CONSTR . ADD/ALT �Q SIGN Q � " Q;",� �DEMOUSH� •
<br /> � B � INSTALL :�' �REPAIR'
<br /> PROPOSEDsUSE� Q� 'SFR Q 'COMM,� Q OTHER "" ' � _
<br /> TYPE OF CONSTRUCTION_� � -Q ' `.,BLOCK�' '�Q, ,�. 'FRAMEr Q STEEL Q, , , �.
<br /> DESCRIPTIOPI OF WORK ` �eS� � G� G��}- � �,- � � �D� �j� _ �
<br /> @UILDING�SIZE� • SQ FOOTAGE .. , :,HEIGHT�..... - . ' ,
<br /> OBUILDING , $ , -7���;a.::;.. -,,r��_ .' . . •, . - , . . , .
<br /> , VALUATION`a�TOTAL'CONSTRUCTION
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<br /> QELECTRICAL $ - AMP SERVICE �[� PROGRESS ENERGY []. W.R.E.C.
<br /> QPLUMBING. $ - � �
<br /> - �MECHANICAL � $ ���� � � VALUAI'ION.OF MECHANICAL,INSTAL•LATION
<br />' Q�S .Q ROOFING ,Q SPECIALTY Q OTHER '
<br /> FINISHED FLOOR ELEVATIOIVS FLOOD,ZONE AREA [�]YES. NO .
<br />� BUILDEFY COMPANY �
<br /> 31GNATURE REGISTERED Y/ N ' �E CURREn'_ , Y/.N__ : .
<br /> Addre�s ' - ` � � Ucense#: '
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<br /> ELECTRICIAN :. ,s '`' COMPi4NY : `
<br /> SIGNATURE � "' REGISTERED Y/ N F�cuR�n Y/N � �
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<br /> Address • , . `L-icense#� • = � '
<br /> PLUWIBER , ' � , : COMP,ANY� .;';;� �::. . . . : .
<br /> SIGNAYURE `: _ . , ,REGIS.TERED;.. ,�: �..Y'/<.N �. .. FEE'.Cuw�en. - `Y/`N:'"
<br /> :..... ,.
<br /> Addre$s � ., ,, � , :.License#< ; . _ �
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<br /> � � .,., ,�i
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<br /> MECHANICAL� ' �y'��,,,, � ,�...,,,; . : :, ;.COM.P.�NIf�; >,. ... . :�fR S l'd �f!-1J2 '�`'!G�L/�!G
<br /> SIGWATURE � �'°' (/""''�"`-' � REGI$TERED, , ;:.;Y.,/ N'�.,;� FEE'CURRE� =Y:/�N'�: �.� •
<br /> Address' '��I7'7I_� :I�LA� �Q� � .Z J�/LL5 , ,_.L•icense# ��'0�3�'T� •
<br /> OTHER __" .: - .': , � ..COIyAPANII� , -
<br /> SiGNATURE. _, - - , � , _ - , .. . . :. , -;. �
<br /> �REGISTERED, Y/.N:.� . ;F��:�uR��, �YJ.-NI-. , _ , ..
<br /> Addr�ss.., , . - t.''^s;�: ` - � _ , . , ., � • °License#� . , . ,.
<br /> RESIDENTIAI;....-,�Attach�(-2)3Plot;Plan§;�(•2);sets:of;B'ullding"Rlans;`.(1;sefof�Ene�` �Fomis;R=0-1NyPerriii't:for'newcon"stnictlon �. ��
<br /> ) . r9Y . . _ �.. .
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<br /> ,;,;Mlnimum�.tem(10);v�iorking�,days;after,;"s`utimittal�dafe:Y=Requlred ohslterConstrucd"on?Plans;�StoRnwater�Plans w%'Sllt Fence Instelled,. -
<br /> �SanitaryFadlitles8��l,�dum�ster,Sife;y,.Ilork;PerjmJF�r;subdivislotis�ergeprojects:.`:�`:s:;ya��='�'� '� � - ` ' °� �- •�
<br /> COMMERCIAL Attech(3j°co'mplete`"sets of'Bulldirig`Plans plus a Life Safely�Page;(1)set of Energy Forms.R-0=W Permit for new oon'afructton.
<br /> Minimum ten(10)working day+g after submittal date. Requ(red onsite,„Constructlon Plans,Stormwater Plans w/SOt Fence Installed,
<br /> Sanitary,Faciiides 8�1,dumpster...Site,.Work-Pe[mlt,for all�newipiojecCs:i411'`commercial.requirements•must meet compllanca � .
<br /> SIGNrPERN1IT Atfacii`(2)"set`s of Eagineered Plaps:�;�,;,w�r� . "
<br /> "'"PROPERT3!.SUR1/EY required•fgr�all�NEW consWcUon:;.,. - � _ _ _ - _ -
<br /> Dlrections: :�?„,: . -_ , ; _ � . _ .-. •
<br /> Flll.out applicatlon completely.
<br /> Owner 8 Contractor sign.back�of applicatlon,notarized
<br /> If'ov�r 52500„a:Notice,of:Commencement is requlred. (AIC upgrades over�7500) _ � .
<br /> •. .tr`�`a i:"`9u:;-r., ,_ .,_.:. _ -,'.
<br /> Agent(for the contraictor)`'Or:Power of Atfortiey(for ttie�owner)would be�someone with.notarized letter from owner authorizing same
<br /> DVER'THE`COUN.T,ER:P.ERMIT-TING.- -•-•-'(Front:of�Application Only) � _ � -
<br /> Reroofs if shingles Sewers Service Upgredes.,A/C Fenqes(PIoUSurvey/Footage) ___ ....
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<br />'� DNveways-Not over Counter if on pwblic roadways.:needs ROW
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