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<br /> 813-780-Q020 Ci#y of Zephyrhills Permit Application Fax 813-78p-0021
<br /> 1 • Bullding Qepartment .
<br /> Dale Recelved P..hone=Contact�forFermittin
<br /> Owner'a Name ����44 � +Jv Qwner Phane Namber
<br /> Owner's Addrass �rQ l � l 3 � Owner Phone Number � �
<br /> Fee Slmple Tltleholder Name - Qweer Phone Number �
<br /> Fee Simple 7ltleholder Address
<br /> J08 AdDRE3S 3 l�(Q � �J l � LQT# �.�
<br /> SUBDiVISlON � PARCEL tD# ~
<br /> • , , (OBTAINED FROM.PROPERTYTAX NOTIQE)
<br /> WCtRK PROPOSEp = NEW CONSTR ADDIA�T � StGN Q [� DEMOLlSii
<br /> -•e. INSTAI:L �' REPAIR -
<br /> PROPOSED}.USE _ � � SFR Q COMM' C� OTHEF2 '
<br /> TYPE OF CONSTRUCTIOIV < Q - 'BLOCK + `Q FRAME ,[;� STEEL Q
<br /> DESCRIi�TiQN OF WORK ' Z' 'l'� � �j0,� G•r � G.� � �1 �P� C ��, c�.-S
<br /> BUILDING SIZE � � SQ FOC)TAGE��, : HEIGHT�.
<br /> QBUILDING r$ ` -- _ '
<br /> L_�1� VAt,tlATION£OF TYOTAL CORISTRUCTION
<br /> QEl.ECTRiCAI r�" � AMP SERVICE Q PF20GRESS ENERGY Q W.F2.E.C.
<br /> �.
<br /> QP�UMBtNG $ ' � t � �jf_
<br /> J,�i l ��lJ
<br /> „ ,,, ., � • +, XJ
<br /> QMECHiRNtCAL $ ' VAl:UATIONOF,M�CHANICAIlNSTRC6ATlOIV T `
<br /> QGAS Q RQOFING Q SPECtALTY � OTHER
<br /> FINISHED FLOOR ELEVATIONS � � FLOOp ZONE AREA QYES fV0
<br /> BUII.DER ��./ COMPANY�
<br /> SIGNATURE REGISTERED Y/ N FEE CURREA Y/N
<br /> Address _ t;.(cense#"� �
<br /> E�ECTRICIAN: . COMPANY , . , �
<br /> SIGNATURE ' REGISTEREp Y/ N FEE CURREA`f 'Y/N
<br /> Address • . , , - Ucense# � �
<br /> P�UMBER COMPANY .
<br /> SIGNATURB� `� ` REGI3TERED , Y,/ N �_FEECURRE� � - Y•/N
<br /> Address � . � Ltcense# �� • �.
<br /> MECH/�ld1CAt: � - � GOMPAt�tYY,
<br /> SIGNA'PURE 2 � � � REGISTERED , �._.Y.,/ N . FeECUR��. Y-kN =
<br /> Add�ass�;' . _. � - '" License#�� � �
<br /> OTNEEt . ` - ` ' ;CCIMPANY ` - ` � -
<br /> SIGNATURE -•.� ''" '"� -" '�� " � � � `REGISTERED " Y/ N... � FEE CURRE� � - Y/N
<br /> Addres� _ , . ,Llisense#�� �
<br /> .,.,. ,.__.�,r. . .: . ,
<br /> RESIQENTIRi:�°� Atkacfi:{2);P-iot P,.taas;�,(2}sets.of:Bult8inglFlans;(9)'set af<Eriergyr>Forins�R-0-W Parmit far nsw cansbuction,
<br /> F��Minimum>tenr(,1,0)�working;days;afte.r.;"submiftal`clate.t':.Requlred ansite,°Construcdon:Plans,'Stormwater'P1ans w/SIIt Fence installeii,
<br /> . : �--,., .,.....� ,,,. .. , ,.
<br /> SaNta'ryFacilides,;8�1;dumpster,=Slte Work}P„etmit;for;subiJiviSionsAarge_projects_=. . .�.,,
<br /> COMMERCIAL Attach{3)c6inptete se#s'af�Bultiiing Plaiis plus a Cife-S'afetp Page;{1}set of Energy Forms.R O-W Permit for new canstructlon,.�
<br /> Minimum ten(10)woikfng days after submittal date. Required onsite,ConsUucUon Pians,Stormwater Plans w/Silt Fence installed,
<br /> Sanitary Facilides 81 dumpste�.Site Work Petmit tor all new�proJects..All commercial requlrements must meet compllance �
<br /> SIGFIPERMIT Attac,�'{2)'sets�tifEnglrieerediP-.laiis. - �� .
<br /> •"'PROPERTY SURVEY requfrt�d,for_all_NEW canstrucUon..
<br /> Dlrections: - ...�.. � . '
<br /> Fitl out applicatlon completely. ,
<br /> Owner&Contractor sign back of appllCatlon,noWrized
<br /> tf over 52500,a Notice of Commencement Is requlred. (AIC upgrades aver 37500)
<br /> 1� '. ':.�,h..fn��...
<br /> Agent(far ttie�contractor)orPower of'Attomey"(for the owner)�would be someone with notarized letter from owner authorizing same
<br /> OVER'fFiECf3UNTER.PERMiTTING_. ... .(Frantof-Applicat�an�Oniy} . _ ." _ -,
<br /> Reroafs if shingles Sew+ers Seroice Upgrades A/C Fences(Plof/Survey/Faotage) .
<br /> Drivewaya-Nat over Counter tf on public roadways:.needs RCiW' � �
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