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e�s-�eaoozo City of Zephyrhills P'ermit Application Fax 813aao.002�
<br /> Building Department
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<br /> Dat�d2ec�ived . - � - . - � . . .
<br /> " ' 'PhoneCoritactkfor%Fermittin'=�' _.
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<br /> Owner's Name C3'"n. Owner Phone Namber' /�'..� 02:�` t�. . � -
<br /> Owner's Address 1`""w' � � ' -'tivvaerPhone Namber � � �
<br /> Fee Slmple 7'IUeholder:Name'° �_,_, �� ��� i#wner P"ho��Number` �� �
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<br /> Fee Simpl�'fitlehalder.Address � �.,.. � :'��: ' � � •
<br /> JOB ADDRESS � '�. / c7 !'"!� L01f# ��_�, ,
<br /> SUBDIVISION �- ^ . ' �� A.PARCEL�ID# ' o� !02,� -�;' t� 0 � ,
<br /> • ' _ , , ' . . � . ` - ..�(QBTAIMED FROk4 AROPERTY TAX'NOTtCE}: .
<br /> WQRK PROPOSED �i' NEW�GONSTR t�` ''� ADD/ALT � - ;S1GN '`� [� `Q"' DEMOLISH �
<br /> . . , � ., INSTAI:L �8... :RERAIR � . .
<br /> PRt}POSEII;USE = , Q�, ",�SFi2 ," [� ~"COMM' Q 'OTHER` `
<br /> TYPE OF CONSTRUCTION",t `Q �'" .BLOCK�' ,'Q';; �;F.,�RAME � STEEC� :[�] ' : - , ,
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<br /> DE3CRIP710Pl�OF WORK " 1/ ' /r /. fp/�
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<br /> BUILDING SIZE� S.Q�FCIOTAG� ;,HEIGH'f.�. �
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<br /> ,. ._ 08U{LDiNG _ $ -^:�,i:�,,.;,t., ,..�r..��, _...' .. . .. ; :.. . �
<br /> , . , . VALUATION`�'aF`TOTAC'CONSTRUCTION ,
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<br /> QELECTRICAL $ �,``A ��� AMP SERVIGE �Q' PROGRESS ENERGY Q � W.R.E.C.
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<br /> QPI:UMBlNG '$'� .
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<br /> MECIiAiVlCi4L � $ � VAUJPtTtQN.OF MECFiAN1CAL,ENSTAl.LATIQtV . � �
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<br /> QC�AiS . , ,Q, ftOOFlNG�,�, :� SPECIALTY�-� OTFIER: ,,. • ' ��
<br /> 4.
<br /> FIiVISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYE$. . NO '
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<br /> BUII.DER COIWP�4NY: �` � •_ � � . �
<br /> SIG�I�TUR� REGISTERED Y/ N 'FEE CURREP" t a. .Y/N._::;, . , , , .
<br /> �ddress � i � ,�L:ice�nse#, ` - .
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<br /> ELECTRICI�4Pi_�r.:. � � ,, � COMPANY• � ' " ' _ ` , - _ �_ -
<br /> SIGNATURE y REGISTERED Y/ N ��Giit�en �:Y/N '
<br /> Addre�s ,,. , ._ , . . . , f-., ..- License:#!�:�'' ' �• '.'" I
<br /> PIUMHER � , ,t . ,COMPANY.>; _ + " - - � . .
<br /> SIGNa►TURE'' - .' • , :REG�ST,eREIp;_ _ ,,v;:<:aY/;�N;-��. ,. F�;Cuwien� `- '-Y/:N:�
<br /> Addres� - � � .� ' ,.Ucense#.� � . ��
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<br /> NIECMANIGAL.' � _ `�. , , . -GOMP/,�NY��,. 12t"�..5- '�`�c.� .rYl f.�6� _ . , �
<br /> SIGNIATUF:E ` CT' REGIS7ERED `N-.,' ; _;_.FEE'CURREA� � .
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<br /> Addre�= �' ,�*/'- . � � ' � � .L'~icense#:I./ -,��C���-�7�J �-'l=� .
<br /> OTHER . ,. �. .r�`z � 7, . . �. , . ., , "a P> .., ;°r � •' ,. ' .. . --�F = - 4 � � - � ' ' .
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<br /> SICiP+IATURE: . :�, - .;:�,tr: , . ,. ,..�:� �i. < ,n.� .,.-, �.. ,,. .. :. . ,., =., {-�-::_:.,� � -.. . ., ,..
<br /> `:3; :�REGISTERED � •Y/.N:._ .:FE�:CURRE��� •.Y:/�N:;� >;,• ..
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<br /> Addr�s�s :-�-:.•- •�t:' - � ``L'icense'#�I�� y I
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<br /> .RcSIDENTIAL�' :*Attach`/2 j Ptot'Ptans�;i(�f`:sets.of,Buildi'n"A',Plans�`.�1�'set of�Enem ��Fomi'�R-t1=W:Perm�iE.for',t.t�w'construc6'on� , . . � -
<br /> 4 ,... ,•,\.�.>_.,. r,\�'+�, O ��.��:.-.� _;� •�y ,��ti:�"- ....7'�,.:;a.,;.,7�.,a�cr"art.:.--,'.;?"-.�
<br /> " �.Minimum�ten;(10)_}working+dajh,s;afte�;'sutimlftiil-.iiaCe:a�Ri�uired.on`slte;�iGonstruction�Plans;-Staimwate'r,°P..lansw/-SIItFence.installed, .
<br /> . _ ' ..,. :,�Sanita�'µFaqi�ltles�8�tu1�d�r� ter Si e�kVorfc{Pe�ilE�o',r,,.;s,ubdtvi�lan�ar9e.Pro3�cts. �t��.t. •` .�Y._ ;' _ � _.r � � �_� .
<br /> rY'.=. �.,..wx�.:.._ ,�,� -'... =:f : ,:�,�, :,:, , .
<br /> CaMNtERC1AL' Attach(8j�coritpiefe"sets o�ult�irig Plans ptus a Life 5afetyr F'age;(1)set of Energq P4rms.R-O-W Permit for new coristruction.
<br /> N1inlmum.ten(1 p)working days after submittal date. Required:onsRe,,,ConsVucdon Plans,Startnwater Plans w/Sllt Fence installed; ,
<br /> ' Sartltary,Fadti�os&:1;�dumpster..Site Woric.Permtt�fo,r..all;new,'pr+ojects':All'commerdat:cequirements:must meet campiEance : , _ ,
<br /> SIGN PERMIT Attacti`(2)sefs of`Eng"��,i�er.ed;Plai�s:y-�;��•=,�- ,. ._. . � .. . , � , ., . - ,.
<br /> """PROPERIY.SUR1/EY:r�aqulred,�,lgr;;,aII,.NEW�cons.truction., - _ - ` ,�- ' "� , � - .,
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<br /> °Directlons: . :'�':�s<ry." : � �..,... _ . ._�.. .. .. _._. ._. . .. - : .
<br /> r�Flll�out applicatlon completely.
<br /> �O�nrnar&Contcac�or:slgn bac.k•of..appllcaSon;notatized
<br /> lf aver�62500,a;Notice.of,:Commena�ment.is requlred: (A!C_up�radea over 57500)„�_�, °r.� � �
<br /> "�[i-;a;<`r,t:_,:}�,�.,:-..: .:.�,,,,-...,. -.._....<...:.....:....._...,.__,._......,.. ..,a, .,.. .
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<br /> " Agent(for tkie ccntr�ctotj-o�:Power of Attdirisy(foi'Uie:ovrciei)woutd`be som�one with notarized letter from owner autho�izing same
<br /> ' 'OVER'THE�COUNTER�P..ERMITTING�=�';;':�(Frcnt;of�ApPli,catiori Qnly)" ' • �:-' � , - ._ . .
<br /> Reroofs ifshingles Sewers Service Upgradas NC Fet�,ces;(PIoUSurvey/Footage) ,+ - , �,:; � . - tY �� ,- v
<br /> D�ivewr�ys-Not over Counter if ompublic roadvuaye::neetfs ROW� �..:"� . � � t +, . _ . .
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