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<br /> a��a�so-oozo City of Z�phyrhills Permit Application Fax 813-78Q-Q021
<br /> Buliding Department � �
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<br /> Date Recetved {
<br /> � . '-,PlionaCoetacfi.for Psrm3tNn :_ �
<br /> Qwner's Na le �t �� vlvti �,_ Owner Phone Number ,
<br /> Owner's Add�ess 3�'-�"�$ �"� � , V�, dwner Phane Number � � ;
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<br /> Fee Simple T tleholder Name Owner Phone Number
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<br /> Fee 8lmple T eholder Address °° ;
<br /> JOBADDRESS �C.� �I Sfi ��• LOT# [�.� �
<br /> SUBDIVISIQ� � � PARCEL ID# �o���iP"�,t '��?.�'�O)Da— {�17�
<br /> (OBTAINED FROM PROPERTYJAX NCTICE)
<br /> W4RIC PROP�t}SED , '°NEW CONSTit' �, ADD/ALT � SIGN' Q Q DEMOL�SH ,
<br /> l e INSTALL 8 • REPAIR �
<br /> PROPOSED i�lSE Q SFR �. COMM C,� OTHER �
<br /> TYPE OF CO STRUCTION-`� [� BLOCK �' Q FRAME [� STEEL Q '
<br /> DESCRIPTId -OF WORK �S.A..� �Y�tst.�1 '(�Q..l►Ji t� iID�.S,R.� - '
<br /> BUiLDING SI,Zf �� � SQ FOOTAGE�_�, HEIGH7. �____y� �
<br /> Q �"�}'�d� _ _.1Sr.,,.� . . , ,
<br /> VALUATION•OF�fbTAL CONSTRUCTION ,
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<br /> su��.a�rt�
<br /> $� , � „ �
<br /> �E�ECTRICAL $r� I�� � AMP$ERVICE � PROGI2ESS EEtERGY � W.R.E.C, i
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<br /> QPl:UMBlNG' � � ` � ��,J (
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<br /> QMEGHANICAI $ VAt.UATIOtd OF lV1ECFiAiU1CAL INSTA�lATION ���
<br /> OGAS i Z I
<br /> Q t�00FING ,Q SPECIAI.TI-� � OTHER �
<br /> FINISHED FI.QOR EI.EVATIONS FIOOD�ONE AREA QYES NO j
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<br /> BUII.DER COMPANY i
<br /> SIGNATURE RECaISTERED Y/ N "�E cuRrten Y/N ,
<br /> Address, " � License#`� �
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<br /> EIECTRtCFAtd COMP1iNY �" ' 1Qt'"�� �12. 't�-'��1f�_
<br /> SIGNATURE �' REOISTERED Y/ N FEE CURRE� Y/N �
<br /> Addres� ��'$2•� ���• JR.�� � � `a�3 ucense#;�C.13 Z�U l�� �
<br /> PLUMBER COMPANX� -
<br /> SIGNATURE '� REGIS.TERED - Y./.-N. . FEE CURRE�- Y/N
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<br /> Address; ' License#� �� -� �
<br /> MECHANIC ' . " COMPANY.-
<br /> SIGNATURE � X_ ftEGISTERED . Y.,/,.N . FEE CURRE� ,Y/N . �
<br /> Address' - � " � Ucense# � � � �
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<br /> OTliER . � . , COMPANY... , i
<br /> SIGNATURE: �' - --. - 'RE�Is7E� Y/ N . FeE CUR�� Y/N '
<br /> Address . _ � � . L'lcense# ���...... � ,
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<br /> FA, ,
<br /> - �RES1DENi7 ' :�',�_:Attacti(2};PIot,Plans;..�2}�sets�of:8ii!lding�E?lans;:{1.}°sef`af€na'rgy�Fomis:'F2=0-W Penrtii#forne+itir canstructlon, ,
<br /> Minl,mum;ten°(�1:0)tworking,days;�;fter,.subiinittal':date:=Required.anslte,rConstnicNon Plans;Stornriwater'Plans w/Sllt Fence Installed, �
<br /> � �3anitary Facflities-&�1:Sdurnpster SIte.Work.Pertnit:for;subdiri5tons(latge,projects •" ' � � �" ;
<br /> COI�6MERCiAl. Attach{3}�complete sets`'of Suildtrig Plans�plas a Ufe"Safety Page;(1�j set af Energy Forms.R-Q-W Permtt for new wnstruc�tion.
<br /> Minimuen ten(10)working days�after submittal date. Required onsite,Construchan Plans,Stormwater Pians w/Silt Fence installed,
<br /> . San!lary Facflitles 8�7 dumpster.Site Work Pemttt tar ait new;pro}ects::Ail commerciai requfrements must meet complEance s
<br /> SlGN.PERMITi Attacti{2)sets ofEngines�ed�Ptans.,,4•�"�"�•-n'�,r f .." ;'t: : ; r . -
<br /> "'"PROPERTY SURVEY requiredbfor all,NEW_canst[ucUon., ._
<br /> Dlrecttans: ' .. _ .
<br /> Ffll out aRpNcaUon completely.
<br /> Owner&�:ontracMr stgn�back of appqca�ao,notarized
<br /> tf over�«�00,a Notica of Commencement is regulred. (AJG upgrades over�750Q)
<br /> " Agent(fa�r,the cbntractoi)tor PoVver of Attomey(fn�ttie ownerj would be someone with notarized letter from owner author�ztng same
<br /> OVER THE C�►UNTEi2.PERMITTiNG� � •- (Front of Applicatlon Oniy)�-
<br /> Reroofs If shingles Sewers Service Upgrades AIC Fences(piabSurvey/Footage)
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<br /> Drlvsways-Not over Counter if an pubita roadways..needs ROVV ;
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