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813-780-0020 City�of.�Zephyrhilis Permit Application FeX g�3a8aao2�
<br /> � Bu#tding Depar#ment
<br /> Date Received �=Phone-.Gontaot`for;Pernti#tin � ,-... _. - -. ._ -• ._.
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<br /> Owner's Name _ �{<l; ' r� . . �-_�.: ;_..:.. . Owner P6one Number X� b�� '�3 1� ` � lr,,�� '
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<br /> Owne�'s Address , gG� l� ���n� Cp- :� l tr a1f i t _�-Owner-Phone Number MV , -
<br /> Fee Slmple Yltleholder Name � �3� � Owner Phone Number � �
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<br /> Fee"$imple-Tltlehold�rAddresa � '* `
<br /> JOB ADDRESS � � CJ '� ��. �- :` J c� l 4��, ^ " - LOT#��_.._,.�1
<br /> �SUBpIVISION , , �� ", �� �RARCEL•ID# ' !^o�(o-,-- ,I '-~ O C�I d`�=:-�'L;;d;.�+,"'„�` �j.--d j�o 0
<br /> - . . _ (QBTAINED FRCN!PROPERTX TAX NOTICE)., : .�
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<br /> WORK PROP,OSED �� NEW CONSTR ADDlALT� ``�-' ' 'SiGN� ''CJ`` �` .�' �`Q�����j 'DEMOLISH ,f ��
<br /> � , INSTAI:L �. 8,„ :,' `-REPAIR _
<br /> PROPOSED-USE; � °�: '��SPR' � ;CONtM � OTHEF2 . ..� - ,,.. `\ ` . :: �:.5�,: ,.,
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<br /> TYPEOF CONSTRUC710N'., '':` . `� �BI:OCK �• . � - ._- ,. � ,. �� ,;. .-, ,�
<br /> Q .Q' - .FRAME ;�,. STEEI._ - . , , >
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<br /> DE3CRIP710N OF WORK F '�� � I C3 �1 .. r,�.C I'l a �, :'� .,�G ,., ',GJ�" t
<br /> BUILDING�SIZE�- � ' � � ,� SQ.FOOTAGE �Q^!� � .. .- ::HEIGHT �� ' Sttl r � � r e
<br /> QBUIL`DiNG , $ �VALUATION`��1F TOl'AL CONS'1'f2l7CTION.? -
<br /> ��� ...... • � , , . -.
<br /> QEI.ECTRIGAL : `$ AtrlfP SERViCE � ,Q PRpGRESS E(VERGY Q W.R:E:C.
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<br /> QPLUMBiNt3 � � � � � , . _ ,
<br /> MECHANI+CA!' $ "c3 D VALUATION 13F MECNANIGAL tNSTALIATiON ` r����
<br /> � ��C��' -� l
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<br /> QGAS , �Q ROOFENG-::�Q SPECIAI.TY �.� OTFiER
<br /> FINISHED FI.00R EI:6VATIONS ���� FLOOD ZONE AFtEA �YES NO
<br /> BUILDEit ' COM�ANIY -
<br /> SIGNA7URE REGISTERECf Y/ (V . ; FEE CU[2RED' :,Y./N;:.: . .
<br /> Addreas � , ' LlCerise# � �
<br /> ELEGTWCIAt�1 t COMpANY" , . ,
<br /> SIGNATURE ' '" REGISTERED Y/ N FEE CURiiE� Y./N ..-� .
<br /> Address � � , Y `L•icen'se#.,:�� �.�'�
<br /> PLUMBER � COMPANY� ., ,. � ' '
<br /> SIGNATURE ,, ,REGIBTERED - � - «.:Y f N '� � ��e curt��. Y/N: '
<br /> � Address . , ., ,License#-� � �
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<br /> MECHAI+ltCAi: '.:COMpANIt� ✓! q'f" �e,rt�i�� ��tii �n.
<br /> SIGNATURE - .:-ReGISTEri�D. �.�X.;/'.N: . : .F�CURREn ��Y/id' �� • -
<br /> • Address ' 3` . /a ci�`'r.� � e r/ Cj. , s ' ,L'fc�rise.#.C/7��� fl� �i `7 � I
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<br /> �,SI� A E ����'1 G�C"�"') '� 3"�� .REGIS'TEREO Y/�N:. . -,FEE,CURRE�' Y.-�/.N::�:: w
<br /> Addresa . . . -0�N{f!'<,-^ , . -- , = . , ' �Lice"nse'#�� ��
<br /> - :���.� - - ^.t.,�r��;�,;�» � - ` _ ,.a:ir.,�;:>j.;*;;.�., � :- .: .:a;-;•-,.�_ . , , - ,
<br /> ��;-,. : :. ,..._; ... ���' ''-�._�--. "ii?truct(on�-
<br /> RESIbENTtAL�:�.=:�Atta�fi,;{2)':PIct�Pian§;:(1)`sets:of`Buitdi`ng'Pians;`•(1)set`of�Energy'Eorms:R-0-.W.°Perm�t.for':``new,�cd s
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<br /> - r.Minlmum�ten;,(1a)rworiting�d�ysta[ter.,�s eq -�..�` '�� �:- ' ' te a" wL SIIt:F'snce Installed.
<br /> utirultte"I:dat"e':y R ulred orisite;Co''nstnicBori�Plans;-Stormwa rPt ns
<br /> . '�<Sanftaiy_Facftttl,es;&:1�;�dur�pster�Slte;�W�ri�caPei�ciiE`for=sia6iitvisloii�liacge::pinject`s;``•.�;;;s:'4,'.,,,-.:.,._ _ _ . .
<br /> COMMERCiAL Attach(3)imm'ptiete`'�efis�of Buiiding'Plans;ptu`s�a L`ife Safeiy Page;`•(1}se#.of;Energy,Forms:'R-O-W Permlt+fo�neinj�constnicdon:
<br /> Minfmum ten(10f working dajrs'af#er submittaF date. Requlred on&fte,Construcdan Plans,Stortnwater Plans w/Sitt Fence installed,
<br /> Sanftary Fadlitiss&1.dumpster..SiteRWarlc Permtt fqr alf`new�projecfs:=Ai1 wmmerdal:regulrements:must.meet campilance ' .
<br /> SiGFI PERMIT Ai#ach(2)"s,"ets of'Englneered:P(ansh�:=h-:;u�" ._ __ .. ,
<br /> "'"PROPERTY SIJRILEY regutred fQr@II�NEW_construcG&n.;, �
<br /> Directians: _ , ;t„c:,a,, e' � -- - � - :i , . . __ .r
<br /> F(11 out appUcatlan completely.
<br /> Oin+rter.,&Conirac�or s�gn back-of.appltcatlon.notar3zed
<br /> If aver'y2500,a-Notice.af.,Commencem�nt la re,qulred: .(AIC:upgrades ovAr.ST500) , ,
<br /> `-- -�:t�?,;.'z�Y�,cr;;;*tt-tc.
<br /> "• Agent{far.Nie contractor�or:-Power'of;Attortiey(fii�tfie�owner}woulif 6e someone'with notarized fetter#rorrt awner suthoi}ztng same
<br /> DVER THE`COUNTER�PERMITTING�-� (Front-of Applica8 n Only)
<br /> Reroafs;if shingles Sewers Service Upgrades A7C� Fences(PlodSurvey/Foatage�
<br /> Drlveways-Plot over Counter if ompublic roadways..n eds ROW l
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