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813aeo-oozo City of Zephyrhills Permit Application Fax 813-780-0021
<br /> � = Building Depar4ment
<br /> Date Recelved , -' � ��. : �g� _ �O`� �
<br /> , , � "Phone ContactAfor'Pe`rmtttin .�
<br /> Owner's Name d�1/�1��!'I"7 /1� /' G�- .'�'�� Owrner Phone Number 0��� 3���Z-� �
<br /> Owner's Address �'�.�__ .,1 =�j�/� � 'l�-J� Owrner•Phone Numtier � � �
<br /> Fee Simple Tltleholder:Name��� � � ' Owner.Phone Number '" � �
<br /> ,. _. , ., . ;�. _ _ , - , . ._ - .. '. -
<br /> F�e Simple Tltlehold�rAddress � ¢ •- - � �
<br /> JOB ADDItESS %3 y C1-�/�+@�/�,! J'1L¢. � � �l�� � '�� LOT# �
<br /> SUBDIVISION ' . ` - , PARCEG ID#'' �� 'a��P '02� '` `��7�' �!��G `���' y. �
<br /> . - • : � " � (OBTAINED FROM PROPERTYTAX'NOTICE)` ` - �
<br /> WORK PROPOSED "'�, NEW CONSTR � ADD/ALT � SIGN' -Q;�" � �'� Q�"' :A DEMOLIS.H , - ,_
<br /> ,. ` : B ,-, INSTALL � :�-� -REP�IR � , .. ` . `
<br /> _�. �• .... ..
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<br /> PROPOSED:USE , Q � 'SFR � ;COMM ;_ Q OTHER` "�-'
<br /> TYPE OF CONSTRUCTION_ �Q' ''BLOCK�'�'Q�„��`'FRAME, .[� STEEL Q; . .
<br /> DE3CRIPTIOPI OF WORK }' � C �i��-I"N �i�p/,(,� . .._p�s �D/� r p� �.D�Z OJ4I G/U , -
<br /> BUILDINGSIZE- � ' $Q�FOOTAGE � 4HEIGHT:`. - `
<br /> � �_�. .,�< , . ,,-
<br /> .�.,
<br /> QBUILDING $ _ „z'�.�+`�::.. _,.r�;,...-..._.,.. ` .... - . _ - -
<br /> � , ,` ' VAF:UATION`'dF'TOTAL-CONSTRUCTION ,
<br /> " . , ,.�, ._ , .. _ ,. .
<br /> QELECTRICAL $ = AMP SERVICE " �Q' PROGRE3S ENERGY 'Q. � W.R.E.C..,
<br /> QPLUMBING --$ ' ' � " � �
<br /> OMECHANICAL $ ' �' VALUATIOiV��OF MECHp►NICAL:INSTALLATION �
<br /> 0�800,l� '� 4 �
<br /> QGAS - Q. - ROOFING,.,,:Q SP.ECIALTY-0 OTHER' ' '
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES. NO ,
<br /> BUILDER COMPANY � " - � . -, I
<br /> SIGNATUitE REGISTERED Y/ N. `_FEE CURRE�'`.'_.+4 .Y/N. �•: _
<br /> Address . , f 'Llcense#' .
<br /> . ,.- .
<br /> .. : ;. �. , . �. - ., .. .,. ,..,
<br /> ELECTRICIAN::;� ;: - ,z '`� COMPi4NY 'Y� .. ` , �
<br /> SIGN�►TURE - "' REGISTERED Y/ N F�cuR�� 'Y/N ��
<br /> Addresa , , � -�.Ucense#: � . , _
<br /> PLUAABER '. , , , . : COMPANIf_. .-,�., r� -; : ., _ �- ,
<br /> SIGFIAYUi2E - ��. . .�,, 4REGISTERED: ••k� : �Y'/�N , t. ,FEE�cuttREn ., ; -Y/N:':� . -
<br /> - �; L, �� . : ., � - • ., . . . �
<br /> Addr��s . , License#, � .- .. .
<br /> � ". ,;. � ,, .,,= a..... � ._ . ,.
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<br /> MECHEWICAL: _ , ��L , '_ -- - .. �:� �COMP/�NY,: � �'. R:S. -. /1/L 7-.' �
<br /> SIGNATURE `- _ :'' �7�� - REGI�STERED:, . ; --.:Y;/`N: : -,:EEE CURRED' = �Y'/-N-�;:• � '
<br /> Addres�.> ' `���f'� 7-� ]CC.6=Z- i[.L�S , ,,_ . .ucense.# ,��/,,�J�.��':�rt�°.
<br /> OTHER . ___: - ' . � ;, . . , ,COMPANIf• .� . -_ L� : . ,-, _:.-. . ,_ ,
<br /> SIGWATURE �-° ° • . . ' ` �REctst�o Y/<N. ;E��GuR�n -.Y.:L,H:�. . , . - , .
<br /> �►ddress .:�'�4� - �=�%:aC'�� k. ;'... „ _.... , - � , `L''fcense"#: . . - .. ,.
<br /> ,.:, . . . '� .:..;.::,�: .;.,:.t..;:;;•:•.;:�.:�,�=�� � =s:<°.._...,,,:��:�;.�-.;`-:.r-.:`.j'•">:ri�.: ;':,#.�..:_.p�- - �._ . , ..
<br /> � R�SIDENTIAI:'. :`Atta'ch;`2 4P.;1otsP.,lans;h 2�sets'''o'frBwlltling?P-.lans;(1.),sef'°of��nergy�Forms;�R-0=_,W..•,Permit for.newrconstruction; _ _ ' .
<br /> ., � , �..) . �..),. .: ...� .... _.. . .. . - . ,',. ..:.
<br /> � inimum=.tern:•�10;�worltin �a"s'after,>>submlttal�tlate:�Required`,onslte;;Cons'triicdori�Plans:�Stomiwafe�;Plans w/Sllt Fenqe,installed,, •
<br /> �..'''a;M.. __ (,y..),.._ 9.>...Y�. . : . _,. .. .,, ,:�. - .. _ _ , _
<br /> Sanitay.�Fadlides:���•�dumpstar�Site�,� or1i.PEerrn�t-:��,r;sutidivl�loris]large`proJects':,:�'�b�`":�����,�:. . ----_ - • - __ _
<br /> rY _,;,,F.:,:w�.,��.,,.�r,,, :�_� .e,�.k�..�,._. ..� .;.�..f4� :._:,: : ..:_ ;. .�, � : •:. . _ .
<br /> CORAiYIEliC1AL Attach(3j�complete'`sets of Bullding'Pians plus a�Life Safety Page;(1)set of Energy Forms.R-O-W Permit for neW constnicUon:
<br /> Mfnimum ten(10)working days'efter submittal date. Required onsite,.Constructlon Plans,Stortnwater Plans w/Silt Fence Installed, ..
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<br /> Sanitary,Fadlides.;8.,�1,.dumpster.,Site.,Work,Perrnit for;all;new�projects:�i411:commercfal.cequlrements�mu�t meet compllance -
<br /> R ,Y
<br /> �$IGN!PERfNIT Attach'(2)'set§of�E�gi�eered4Plans� ::r.'s���'=:�_..' -. .. - , A ' � ,
<br /> .,
<br /> "••PROPERTY SURT/EY required for;all;NEW.coqs.trucyon... --�� _ - �
<br /> - - :;�:- _ -
<br /> 41'rectlons: :�.: ,. . . ..... ... .. . ._ _,. . �
<br /> FIII'out appNcaUon completely.
<br /> Owner 8 ContracMr sign.badc of appl(caHon,notarized
<br /> If`over�2500,a..Notice of:Commenc�ment la r�quired. (NC upgrades over•�7500) ,. �. . � -
<br /> .,s �?-'��'-...:.. ......�„�.:._. ._
<br /> •• f;.,:;':t�a,y,..»:d;.c,,,
<br /> AqeM(for ttie'contrector)`or:Powe�of Attoiney�(fo�the:owner)would'be someone_with notarized letter from owner autho�izing same
<br /> OV,ER'THE.COUNTER�.PERMITYING-'-="--� =(FronE'of=ApplicationOnly)`�.�
<br /> ReroofsJf shingles � Sewers Service Upgrades A!C Fences,(Plot/Survey/Footage) -- --- -�: - . , �
<br /> ..,_ „ _.._�_„_..._...M�... - . .. . . _ ._�.-��� r ...� -'; .�., __ . , .
<br /> Driveways-Not over Counter if on,public roadways.:needs ROW� � �
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