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<br /> 813-780-0020 City of Zephyrhills Permit Application
<br /> Fax-813-780-0021
<br /> Building Depa�tment
<br /> ` ''-i -� � � � �i3 � �a _ (�oqy
<br /> Date Received I Phoc�e Contact for Permitting -
<br /> �5I e d.! NQ�1C �U�' ( Owner Phone Number (J��t'� ���� '�?� T
<br /> Owe�ee's.Name .
<br /> Owner's�Address;�. ����� �Un"���� '�'(� ��' �0. �e Owner Phone Number
<br /> . , � ���S Owner Phone�dumber
<br /> Fee Simple Titleholder Mame
<br /> Fee Simple Titieholder�Address . � ��
<br /> .DOB,ADDRESS`�. J l �� 1 �� u�-�i m �{���. . h r h�i I 5 .Fl 3 3 5�+�� �.�T#
<br /> S�Bd��,s�o�� . �d o��-��S ,P�����:��� 3�-a s-a� - c�9a�oo�o� - d y:�r o
<br /> , , " �(OBTAINED FROM PROPE6iTY TAX NOTICE)'
<br /> WORK;PROPOSED�, NEW CONSTR ADD/ALT Q� SIGN Q MOVE Q DEMOLISH
<br /> � "' B � INSTALL � REPAIR J
<br /> PROPOSED USE , Q SFR 0 COMM 0 OTHER
<br /> TVPE OF COf�STRUCTIOPI � , BLOCK � � FRAME Q STEEL Q OTHER
<br /> DIESCRIP�.,T•,ION;OIF�wota�c; � Q�0� (e-ro� a`I s �.��s A F�f m h����rl.Q �l� � oI a�� � Q ' ��' Sh� '�
<br /> BUILDING SIZE; , ,- ,<SQ,;FOOT/4GE �LI�� ' HEIGHT
<br /> � BUILDING $�-,;:(���-`;-�;;�';�:;',��.`��;;'` , ;;�/AL9JATICQN�:OF=TQTAL,CONSTRUCTION • .
<br /> '�'�;. , ;,
<br /> 0 ELECTRICAL $ AMP SERVICE 0 PROGRESS ENERGY Q W.R,E.G.
<br /> r,�,_'�"
<br /> Q PLUMBING $ ���� �'
<br /> � � f(��p 3
<br /> Q MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
<br /> �
<br /> GAS Q ROOFING � SPECIALTY Q OTHER �P� ��v /�
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES ONO ��l �j �
<br /> BUI�D@R ' COfllIPr4�dV
<br /> SIGPIATURE REGISTERED Y/ N FEE CURRENT Y/N
<br /> Address ` License# '
<br /> ELECYRICIAN • COfYiPAtdY - �
<br /> SIGNP,TURE REGISTERED Y I N �FEE CURRENT Y/N
<br /> � - -
<br /> Address � • License#
<br /> PLUMBER Cm119PANY
<br /> $IGMATURE ' REGISTERED Y/ IV FEE CURRENT Y I N
<br /> Address License#
<br /> MECii/AP�ICAL COflflPp,fNY •
<br /> SIGNATURE REGISTERED Y I N FEE CURRENT Y I N
<br /> Address ' License#
<br /> ATIi�R''s,k;-- /; ��,y� ;COMPAPIY. (nQf1 ��� —�'�G � . ,
<br /> SlG�1�►TURE!!� _ l�l. � ,'wl/�� - REGISTER�D Y N FE URRENT - IN
<br /> �►aa�ess ���'��J s� 5y (hil�S F( 335y� �'�icense# `G�./tj�:v��(fi�
<br /> RESIDEWTiAI. • Attach;(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction,
<br /> , .,Minimum ten(10)working,days after subrrmittal date.' Required onsite,Cbnstruction Plans,StoRnwater Plans.w/Silt Fence iristalled,
<br /> ' ' , Sanitary Facilitfes�&'1 dumpster;.Sife VVork Permit for subdivisionsllarge projects ` . •
<br /> COMMERCIAL �"Atfach"(3)sets of�Buildirig Plans;(1)set of Ene�gy Forms.R-O-W.Permit for new construction:
<br /> Minimum ten(10)working tiays after submittal'date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
<br /> Sanitary Facilities&�1 durripster.Sfte Work Permit for all new projects.All commercial�requirements must ineet compliance�
<br /> SIGf�PERMI'� Attach(2).sets of Engineered Plans. . •
<br /> *"'*PRUPEFtTY SURVE`(`required for all NEW construction. • . . , �
<br /> Directions: � ' �
<br /> Fill out application completely.
<br /> Owner&Contractor sign back of application,notarized
<br /> Yf over$2500,a Plotice of Commencement is requi�ed, (A/C upgrades over$5000)
<br /> '* Agent(for the contractor)or Power of Attorney(for the owner)would be someone with notarized letter from owner authorizing same
<br /> 'OVElZ THE COUNTER PERRAITTIP9G (Front of Application Only)
<br /> .....r.•,..•
<br /> ,,Reroofs ,_, -�•�--Sewers=` "' ='�Service.�lpgrades A/C Fences(PIoUSurvey/Footage)�•° � ` � • •'� � � ` '�` "`��
<br /> -, • - . ,_ . ..• ;t :� .., .
<br /> � ., - . ; �- ' • � 'E
<br /> �`,; Driveways=Not over Counter:if on<publi�roadways..needs ROW ' � �• '
<br /> , , , � � •`;�S��.i'�' " `! , . , � _ :� , ;.5;,: ;J
<br /> � . �.. , ' .,.. , „� .� i'1
<br /> �i.< ._,r . .-.".... . : ...... . .r.�.�.v,.- .v .t �...._ . .� ..._' " :, '"'�,., r.. .-..... .-�� . ... ,
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