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s�3-7eo-oo2o City of Zephyrhills Permit Application Fax 813aeo-oo2�
<br /> Buflding Department
<br /> Date Received. � . : Phone•Confact•for�P.�m��� �� ���3 - �.g a - Wo�y
<br /> . . ,, . z �/
<br /> Owner's Name �t, 2.� ��.ti�US� ( �i n �0 n Owner Phone Number ��J� �7'��`�"
<br /> Ownar's Addre�s `1. �� �V� ��--�_ h 0 11 i��5�3 3S� " Owner Phon�Number '
<br /> Fee Simple Tltleholder Name ' ` � � Owner Phone Number �
<br /> Fee Simple Titleholder Addresa � ` ,
<br /> JOB 14DDRESS , t7� / (J'� A�I�- �. � Y�('� ��5 �� �����` LOT# C�
<br /> SUBDIVISION �' Sd�� SU YJ , PARCEL ID# Or _���li--a - ����v�a�� '���v �
<br /> � - . , (OBTAINED F.ROM:PROPERTY:TAX NOTICE)
<br /> WORK PROPOSED NEW CONSTR' ' '�'• ` ADD/ALl' Q' SIGN `Q � `�Q DEMOLISH
<br /> e:• .tINSTALL 8 •REPiAIR
<br /> PROPOSED�.USE - Q� 'SFR Q� COMM " ' Q r OTHER � ' `
<br /> TYPE OF CONSTRUCTION Q ` BLOCK' ` Q FRAME Q_ � "STEEC'��Q ' � _ , ' "
<br /> DESCRIPTION OF'WORK. `„ ���,( d1-�t' �e �U'�'t'" ��J l,lC�dPS Q hL,2.�f S►li�1 , 3 J �CG��l�(�� /c�l��
<br /> BUlLDINGSIZE . S�FOOTAGE,'I�1�� _ � , HEI.GH1'��t, ,
<br /> QBUILDING $ �.���� VALUATION'OF',TO'i'AL�CONSTRUCTION J � ' ""
<br /> QELECTRICAL $ ` � AMPSERVICE Q `PROGRESS"ENERGY Q W.R.E.C.
<br /> QPLUMBING ~ $ ` , bC�,b�
<br /> QMECHANICAC $ VALOATION OF MECHANICAL INSTALLATION.
<br /> � ` .
<br /> QGAS Q ROOFIIVG ,Q SPECIAL'TY„:Q :. .OTHER� ,
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES. ,NO
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<br /> BUILDER COMPANY� ��= ` ` � � • � ' '' -
<br /> SIGN�ITURE REGISTERED Y/ N � � 'FEE CURRE� '' Y/N' "' ,
<br /> Address � -=- , � � .. Gcense•#�'
<br /> ELECTRICIAN = .�COMPANY' - ° . ` '
<br /> SIGNATURE ' ' REGISTERED Y/ N FEE:CURRE��'` ° ���=Y/•N`� ` •
<br /> Address ' � � . 1 . Llcense,#: :se.- -
<br /> , � .. -- - - . . • , _ ,.. - ". . , '
<br /> PLUMBER ' ,C.OMPANY �=�- � : -
<br /> - . b..4. .v.. ..�..i" .':' , ��.
<br /> SIGNATURE'` ' ,REGISTERED .Y.=I..N,= .,FEE CURREA_ >�Y•./N.:-,:
<br /> Address � r .. '.Wcense.# ' , ' , _.
<br /> MECHAPIICAL: : � . • �COMPANY • . � - - ,�_
<br /> r-.:�
<br /> SIGNATURE " ' ' ' -� .' RE�isTERE� . , Y.J_N. ' FeECuw��: Y./<�N' -
<br /> Address:`, : . - , � -• , � � , License#' - - .
<br /> OTHER • � .n,�„) � �Y _ ;COMPANY �+� �1�.n [l�C��C -���- � ,
<br /> SIGN�►TURE' - �1 A,Iv`�`��� '�C� '�� � , REGISTEFtEO� ' Y/ N::.'. � FEE.CURRE� Y/N.
<br /> �,de.� ��i��(-1�:�.��,.;�:. �..rl���15��-� �35y � u��se# -�CCC�3a sSa��
<br /> flG�'4E�I IA4�;N.°,: . ( N . ' j:i:i: ^�.. + i�1.':f f' ... ,r .:.C..... .:'.., r e . ' ,- . . -- _. "
<br /> �:AttacFi'(2)yP1ot:Plans;�,(2)§ets:ofsBuildf�ig�Plaii',s;�(1)"sef of Energy�Fo"rins;R=0=1N'Pemilt,ior new conshucUon, _
<br /> •�_.r<+Mlnimum�ten,(�1A��wori�ing'�deys'_after�submlttel daCe k'Required'on"site;':Constiucdon`Rlans;Stomiwater`Plansw/Silt°Fence lns4alled,
<br /> � JSanitaryF,adlides;&.1;;dump�ster;Slte�WorkoPertriltrfor;subdivislonsllarge;projegls;=','.�;�,�; ,
<br /> COMIHERCIAL Attach(3)-eomplete-sets of�Bulitling Plans plus a Life Sefety Page;(1)set of Energy Forms.R-O W Permit for neW.construcdon. �
<br /> Minimum ten(10)working days after submittal date. Required onsite,Construcdon Plans,Stormwater Plans w/Silt Fence installed,
<br /> Senitary_Fadlitles.&1 dumpster.,.Site Woric.Permit for all new�proJects:"All commerclal,requlrements must meet compllance - .
<br /> SIGN PERMIT Attacfi(2)sets ofEngirieer,ed.:Plens:,�, :,�-�':�~ , ; ` . ' �
<br /> •••• . URVEY required for.all,NEW�oonsWction. . •• -
<br /> PROPERTY.S
<br /> Dlrectlons: -�".=... . . . � ,.
<br /> FIII out applicadon completely.
<br /> Ownar&Contractor sign back•of applicatlon;,•notadzed ..^� �,_,."�."�`=`_ T ,,. .,:,-�_._ __ ,_- ;
<br /> If over=2500,-a Notice.of.Commei�cement la required. (AfC,upgrade�over s7500) � ;"-- -- � " ' - � -�- � ��
<br /> �...;:�...:u..�:
<br /> �,f.,...,�,�t. ;� . '_ . „ 'r':.'''Sii•s.,«.;....5,'.r� ',. �
<br /> .. s�:::;-; �.�-. . ..., �... .. ..... :.. . . r:_ � ._ r• ��., � , : ;
<br /> Agent(for the conVactor):or,`,Power of Attotney`(for tFie owner)�v�(�ul'c�be s�omeone with_notarized letter�from owner authodzing•same�, ;?•�. V��.
<br /> .. „ , :,• . :��; � :�,:i .. 5���<. }� , . . - .., . +'� .,, , � , ,. _ a . �,<...
<br /> . .� . � , �`. . , ! e�r?2'';!, 'i Y
<br /> DVER�THE COUNTER�PERMITIING:�.".�:=,�(Fronf_of�Applica8on-On1Y),;;;;.`� �. �"" ��� :�` � ;i =. �� ,
<br /> Reroofs if shingles Sewers �''-.�-_::Sarvlce.UPg�ades=-A/C�.����Fences�(PlodSurvey/Footage) ' . _ :I`'�.�_`.',t,M°i':''lj` � _. s�µ,.. 'k -
<br /> . .. -. .. - - S�..~..w�..s.,..-ar-�++......a.w.-�>•:v. , _ _
<br /> .%a5y.:.a• '":_::' :_, . " .. . ..a .. . a . ...i
<br /> Driveways-Not over Counter if on public roadways::needs R01N�
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