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% <br /> � <br /> e�a-�saoo2o City of Zephyrhills Pemit Applicafion Fax�13780-002i <br /> Buiiding DepaRment <br /> � Dato Rec�ivcd Phone Cen4act for Porml <br /> Ownars Namo Oa�rar Phorta Idumbsr - 1 b3- V S O <br /> Owners Addross 3 N r�- T7v� Ovmor Phorto Humtror <br /> Fco Simple Titleholdar Namo Owner P�ona Numbsar <br /> Fee Slmple Titleholder Address I <br /> JOBADDRESS rl LOT� O <br /> SUBDIVISION PARCEL ID� ' <br /> (68TAIM�FROi9 PROPEFIY TAX NOiSCE7 , <br /> WORK PRQP0.SED e NEW CANSfR 8 ADDIALT Q SIGid �] Q DEMOLISH <br /> INSTALL REPAIR <br />' PROPOSED USE � SFR Q COMM Q OTHER <br /> 7YPE OF COfdSTRUCTION Q BLOCK Q FRAME STEEL Q , <br />, DESCRIP770N OF WORK C L� IC�.1 1 � � L� <br />� BU1LDlNG 31ZE SQ FOOTAGE HEiGWT <br /> QBUILDING $ VALUATION OF TOTAL CONSTRUCTION <br /> QELECTRICAL 3 AMP SERVICE Q PROGRESS ENERGI' Q W.R.E.C. <br /> QPLUMBING 5 <br /> i '. (n.✓ <br />� �MECHANICAL $� � VALUATION OF AkECHANICAL INSTALLATION �I��W <br /> ��$ Q ROOFING Q SPECIALTY Q OTHER ��Ij�7/ <br /> ✓ <br /> fIN1SHED FLOOR ELEVATIONS FLOOD ZOP1E AREA QYES NO <br /> R �t,._ r v_t.ss,��.���• a�in�y e .,p„a� L.� <br />' BUILDER COAAPAPIY <br /> SIGNATURE R[-�is'[Eftm Y/ Pl F�cuRrtEn Y/N <br /> Address Lieense� <br /> ELECTRICtAN CQflAPM1Y � <br /> SIGNATURE rzEoisr�t� Y!Pl �cuar�. Y/N <br /> Addross Licenae S <br /> PLUMBER ��9P� <br /> , g�q�p'T(t� REGISTFFtm Y/N �cuR�n Y/Pt <br />, Address Lice�se# <br /> PAECNANiC RAPANY �-111- �i r �- �i I-i�a�i m'1 <br /> SIGNATU c�sr�o N �cuRREn Y/N <br /> i Addreas Lica�se� � � O �"t <br /> OTHER COMPNVY <br /> SIGtdATURE t��tsT�teo Y/IJ �cuRt�n Y/N <br /> Addmus l�c8nse�I � <br /> 11t11191lillll ➢ 1111981tAlY1BII9091l9ABIIIiA091YlE0109i1C1111A9BLllL <br /> RFCIDENTIAL Attach(2)Plot Plans;(2)sets of Bu�7dirtg Plans;(1)set of Eitergy Fortns;R-O-W Pemitt tor new construCion. <br /> Minimum ten(70)worfdng days after submittal date. Required on�ita,Conswction Pians,Stortnwrater PL�,v�Siit Feram:e aub&�d, <br /> Sanitary Faalities&1 dumpster,SNe Work Permit for subdivislonsllatge projeds <br /> COM�AERqA1 IUtarh(2)complete sets of Bufidmg Ptans ptus a Life Safety Pag¢;(1)set oY Ens�gy Fams.R-O-W Penni4 fw�cva�n. <br /> M'ailmum ten(10)worfcirtg days after submittal date. Reqtrited onsite,C^�n Ptans,Sbrtnweter P4ans w/S�lt Fence ins�e�, <br /> Saniiery FadGfies 8 f dumpster.Site Work Pertnit for all new prqecfs.�commercial riequlremertts must meet eomp9ance <br /> SIGN PERh11T llttech(2)sets of Engineered Plans. <br /> ""PROPERTY SURVEY required for all NEW�nstruCion. <br /> i . .�._aJ_��u� . � a �—e—x Bi��,n,,,�_�-'.-- <br />' Diradiona:• - --- <br />' FW out eppticatinn completely <br /> Owner 8 Contrador slgn badc of appliotian,notarized <br /> N ovcr t2500,a fdoUco of Commoncement Is requlred. (AIC upgradea ovar 576t�0) <br />� " Agent(for the contractor)or Power of Attomey(far the awne�wouW be somoone vrilh nofnr¢ed I�tfer from w✓ner aulhor¢ir.g e-ama <br /> OVER THE COUNTER PERMITTiNG (copy of contrad required) <br /> ReroMs if shingles Sewers Service Upprades AIC Fences(PInVSurvey!rooiaae) <br /> Drtvawayn-Not over Counter if an public roadw�eys..needs ROW <br />