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<br />' s�s-780-0420 City of Zephyrhills Permit Application Fax 813-780-0021
<br /> j � ' Building Department
<br /> I - _� • --- -�•---..._.,,,�.,.
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<br /> Date Received_ ,.= �-� � Rhane-Con#act°for Perntittl +���� ��-�. �� / /
<br /> Owner's Name � ��L J• ���ZG��:r Owner Phaae um er O ��"��� O'� �� '
<br /> wner's Address ���� V� /,�� L�S/�~ L� r / Owner•Phone Number � ,�
<br /> Fee Slmple Tifleholder Name Owner Phone Number � �� ,
<br /> ;.,�1 .�_
<br /> Fee Simple Titieholder Address ^
<br /> JOB ADDRESS x (/ `f' ��f� S � �r S �` LOT# ��
<br /> SUBDIVISION �— �� PARCEi.ID# �
<br /> (OBT/UNED FR4M PROPERTY TAX NOTICE)
<br /> WORK PF20POSED , ~ NEW CONSTR AI3DIAt.T C� SIGN Q Q DEMQkISH -
<br /> INSTAl:L REPAIR '
<br /> PRQPOSED USE SFR Q COMM � 03HE�2
<br /> TYPE OF CONSTRUCTION Q BLOCK " Q FRAME [� STEEI. Q,
<br /> DESCRIPTION OF WORK `�` 1� .l�I� o2�'C" - �P ��"��1�/`i� '
<br /> BUIF.DIT�[G S12E C � SQ FOOTAGE��� HEIGHT ��
<br /> QBUI�DING ,. .� ��C �y�` � -�.•.,:r-,. _. �> .. .. . .
<br /> �� VAlUAT10N dF1bTi4l CONSTRCICTION
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<br />� QELECTRICAL $ '"-�— AMP SERVICE [� PROGF2E55 ENERGY Q W.R.E.C.
<br /> �:..� �• E
<br /> QPLUMBlf�lQi � � . , �1 � ��
<br /> I) C]MECHANICAL �� - VAtUATIQN OF MECHAEVIGAL[NSTALLATIflN -
<br /> . „ � �� Z��
<br /> OGAS Q ROOFlNG [,� SRECIAt:7Y �'-] OTHER `"�j'
<br /> FINISHED FLOOR EI.EVATIONS ��� FLOOD ZONE AREA �]YEB: NO
<br /> BUlLDER � � �G�NlP,aNv'� �' � d�+��'-�c
<br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y./.N•
<br /> Addre�s Llcarise# ( �
<br /> ELECi'RtC1AN COMFANY
<br /> SIGNATURE �' REGI57ERED Y/ N FEE CURRE� Y/N
<br /> Address , �License# �� �
<br /> PLUMBER COMP.ANY
<br /> SIGNA7URE ` REGISTeREo Y/.N FEE CURRE� Y/N.
<br /> Address License# � - �
<br /> MECHANlCAI: : GOMPAPIY �
<br /> SIGPIATURE REGI37ERED Y/ hl Fee cuwten , Y/N-
<br /> Attdress�: . _ - , , , �
<br /> � License# � �
<br /> OTHEFt COMPAl+tll •.: - - - � ,
<br /> SiGNATURE REGISTERED ' Y/ N.. F.EE CURFtE� ;� Y/,N .
<br /> Addl6�$ °t;; , - - �t` ,. - ' , . L`iCeT1Se#-��� �
<br /> .�r -�,...,.,�. : , ., .. -y , . ._ . .x.. , ,o., .t; ,.::• s�-�:.
<br /> RESiD�NTiAL: • Attaoh{2);;_P.,lot:P<lans;:(2}sets:of4Bultd#ng:Plans;(1)-setaf�Eriergji'Faiins;'R-{}=VY:Peririlffor�Fiew,;coristruc6bn, .
<br /> - Minimum;ten:(tU)�wortcing;day,s;after„`submlttai date.�Requtred onsite,�Cdnstruction�Plans;�Storinwate�Plans w/Silt Fence installed,
<br /> �� Sanitary�FaGitties�&al,dumpster,:v�ite�Wark.,Ferrnik,#orsukidiyislonsAargeTproJects�". -�s°<�•' = � '
<br /> V GOMMERC4Ai. Attach{3}`cqinpteie sets of Buliding Plans pl�is a I.ife Safety Page;('f}set of Energy Fortns.32-Q•W Petmit fcsr new consUuation.
<br /> Minimum ten(10)working days after submittal d�t�. Requlred onsite,CsmstrucUan Plans,Stormwater Plans w/Silt Fence installed,
<br /> Sanitary Facilitles&1 dumpster.8ite WoMc Permik for�II newfproJeots:All commercia!requlrements must meet compllance
<br /> SlGN pERMiT Attaeti{2}=sets of Eng'iiieer,ed;Ptans:,::;:�;s�` _ . -
<br /> ""PROPERTY SURtJEY regulrsd,for all IVEU,Y canstructian.,._
<br /> DUBCttqfl8:
<br /> Flll out epplicaUon completely.
<br /> 4wner&Gontractor sign k►ack-of appllcaUan,notatized
<br /> If over�2a00,a Natice of Gomraencernen#i�requtred. (AIG upgra�al�s av�r ST580) .
<br /> M1 . ::lini�.�.:i:•+.
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<br /> Agent(for the contractor)'or:Powe�of Atkortiey(for the�owner)would ba,someone with notarized letter from owner authorizing same
<br /> OV.ER THE COUNTER.,PEl2MITTIFlG. ... -- {Front af=Apptica8on Only) � , ' f
<br /> Reroofs if shinglas Sewers Service Upgrades A/C Fence§(PIoUSurvey/Fookage)
<br /> Drlveways-No#aver Counter if on pubiic raadways.:needs ROW., �,. ' � t � � ' -
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