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a�saeo-oozo City of�ephyrhills Permit Application Fax-813-78(}-0021
<br /> � 8ullding Department.
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<br /> Datg Rscelved � • � - . - - .
<br /> . , - '�Phone Coiitac��for'Permtttiri��:- � .
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<br /> Owoer's Name C!(., °� d-�.�u..4�. C}wner Phoee Number . ` �
<br /> Owner'sAddressl �•'-;, ,� - , � �-_ - , C�weeF-Phoni�Number ): t `�
<br /> Fee 5imple Titleholder_Name� �� �`� " • �" '� Qwner Phone Nui'nber':�I s ... ^ � .
<br /> - � �---- .=+T�'— .. fih- , . ._ . , . . .., "�-
<br /> . � : . . Dry ,. , ..
<br />, Fe�Simple Tltleholder,�4ddre�s�- ; :�,.. "�" � •, - - �
<br /> JOB ADDRESS �{� . ,�. .� . ^T . . . . LOT#.- �
<br /> §UBDIVISION �— _. . �t� PARCEL;ID#'' l�"� �� `��6� ����Jd��d ,
<br /> , �• � _ . _ � �;'(08TAINED FRqIN PRORERTY YAX'NOTlCE�' '"
<br /> . ., , .�= ,.,. � �
<br /> WORK PROPOSED `,: {� =� . . NEw CpNSTR `�'� �_''' RDD/AL'T [� � SIGN � [� �. � [�`;� .DEMOLISH ` I
<br /> � INSTAkL. ,.. �REPAIR�' � �^'' - �
<br /> t� 8. ,. :�F�. ,., . -. ._ . ,
<br /> PROPOSED ilSE `. . Q' e'SFR ., ;� -"COMM ,. '� ''OTFiEFt`_' � .
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<br /> TYPE OF CQNSTRUCTION..` '`�Q ` "'BL'OCKry';' '�C]` �' FFtAME, C__] �.STEEL, .Q -:� � _ ... ..
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<br /> DESCRIPTION'OF WOl2K � � Ci '��'-', � � � �- � "VV,,, C� �.�, �;• �.� �-��.
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<br />` BUtLDING SIZE Y ` � = A . � � . " f -
<br /> $QFOOTAGE , .HEIGHT: ;.�:. `�.", i
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<br /> QBUILQiNG a��;���:__ --�-"�,m..._:_. '' _. . , J, _ , -. - `
<br /> $ ,VAGUATION"aF"1'fJTAL`CONSl'Rl'1CTION -
<br /> .,���-, � • ' - • _ .-
<br /> �I,ECTRtCAt $ ����}� ; AMP SERVICE � PROGRESS ENERGY '.
<br /> r��DO ��� �_�`. -- . _, Q W.R.E.C.
<br /> QPI:UMBING � �; - - _. .
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<br /> QMECHANlGAL ��. ,_ �. , :.,: : _ .'.•` �s` _ .. _. . .
<br /> $ VAl.UA,T,IQN�OF IUIECNANECAl,1PISTA[.LATION
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<br /> ' QGAS _,�: , ROOFtNG:;i'Q SP.ECIRLTY:��'' OTliER` _ . -
<br /> i FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA YES. NO
<br /> C�,� � k .�a��y � . � . :.- -�-. _ .. _ : �
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<br /> eui�.�E� co�w�;arair ��� -.�� . , � ,- � � � - � -
<br /> SIGP9ATURE REGISTER�O Y/ N.. FEE CURRE�'i.'., �.Y/N _-_..:,_ .
<br /> Address . :�:`r � , . � License#�� " . .. , ' � I
<br /> EtECTRIClAN;,. - ��. , . • '„° `�'Cf�MPANY �C.. '� �'��� _ `i!` 4 ��
<br /> SIGNATURE � U �`�'� "' F - '' `
<br /> R�GISTEREp Y N �cu�eP .Y_°/N :
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<br /> Address� � �3 j�f� R- �4 - �_ , , .. !: .•.Ucsrise�#-;�iU�`'�'C�a�o� � �
<br /> PLUMBER � � . __. - ... , '.COMPANY*- - ` � .- . � �
<br /> SIGNATURE , � . . � - .,�.:�, tREf318TEREp� -- d,�.: �u.Y:/psN�_ = • ;FEE_CURRE�' � ��Y/"N::`
<br /> Addre$s - _ : ?�: , t� ' {; , `- '�:,� 1Ucense_#��.� .� . , �
<br /> MEChfAF�11GN:,:. � . .,,_ _ . ; - . �r .. , _.Ct3MPJ4NY, . ~�.,. �;� .:. - - -_.�-,,� -- ;;.,. �_ �
<br /> SIGNATUR� " • , _ . ' �±' - . �`t' .REQIS7Ef3EDs" , �:.Y;/,N= i�EEE�CU,RREP� . .sY/.{V._ . _ ' I
<br /> �iddre�s:; - „ =�:.u.,- ._ ':b<,�, .- , ,:t.. � , ,. - " _. �.�l.lcense.#°�.� `�.
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<br /> OTHER � - � . .:i3 ' . ` . , ` ,y , `- �GOl1I1PAN'x�>, .�s� -
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<br /> SIGW�TU�t�: ,: ' . " � `� " :.R�C+ISTERED :Y:/:.N�ai' " °FE�`CURfiE�-" -:Y:I�Ni' , , _ .
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<br /> �... • .x ; . � _ �y`nl., . . + r. : , _N _ — . . .
<br /> �38's.`.sx; -z. �.i:�.'i;> .. . -
<br /> ���9�$' i.�., '"'^:.;si:. "'ttr '�COflS9'�� �
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<br /> ..REStOEN'11At�:_:="'Attacti{2),P1of:Plans,(2)sefs of:B�Itiiliig'F'laris;°,(1}se#of Enengy'fo"riris:,R=O Vit Permlf far new can'"stnui�ion�;
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<br /> :Mlnlmumtten 4Q workin c!'"a s=atte�;suti itfal"date:`�R` uil�ed ons'ite�'Constnuction�Plans Stormwater Pians w/-Stlt Fence;installed,
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<br /> Sanitary=Fadtiti�s�&:;1:hdu��ter-;�4SItei4Voik;Per,m12_#or:sutidivlslon�/la�.je�'projegts,�;,-��;„�:�,:` -f' _._.. < - --. . � - -
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<br /> COII�iVtERC1At. Attac�t{3)eamptete set's'isf Suliding Plarts ptus a Life 8afety Page;(1}set af Energy Fortns.R t�-W Petmit fo�new construcUon.
<br /> Ml�imum ten(10)working days after submittal dete. Required ansite,ConstrucUon Plans,Stormwater Plans w/Sllt Fence installed, ..
<br /> Sanlmry Faciiitles.&1_:dumpster.,S{te Woric.Permt�for;�i{`new'projeGts;`Aii'commercla4 cequtrements�must�megYcompllance - - _ ,
<br /> � StGNPERMtT Attach'(2)seb=of'EngineiaTed�Pians��.t���.�,�=`.=��.. -fi'•�:�..� - � . . �
<br /> •'"•PROPERTYSUR17EYreguired.yfg�;all;fVEW_;can,s,tnacdo�i.: °, '. - -, �
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<br /> �Directlons: �v"`z,,,. , �� ........_.�.. _.,.�.,�,. _,_ � _ .
<br /> Ffll out applicatlan completely.
<br /> Owner&Ccntractor sign.bac4c:of'appltcatton,notarJzad , .
<br /> If over$�500,a;Notic�,of..Corrrmencement ia r�qulii�a�i: �(AIC�upgrade's over t750Q)._.,.. ��
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<br /> '• Agent(for�ie`aontraotorj`t5�`Ptiwe�of�Attortiey"(for#he�owner)}would':be someone:with nota�ized letter from owner authorizing same
<br /> OVER'TWE GOUNTER�PERNIi7TINt3�=--_ :(Front<of�ApPli'cation'Qrilyj<��.- ;'�� �.;J���;y t - j_
<br /> Reroofs if shingles Sewers �Service Upgradas°A/C,.. Fences,.(PIoUSurvey/Footage) _. �
<br /> ":.:,,_t::""`""'.e..-„...W�:u.: ...... .:...:_.. <,.'=',� --:s.n-i�-`;.Y�.:^:r;' ;:Y7..4, ,. ..,7i-'�s. _ , "�Yr:i�y , _, , . .. -
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<br /> Llriveways-Not aver Caunter if on public roadways.:needs ROW
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