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<br /> � ,, 81•M�ao-oozo City of Zephyrhills Permit Application Fax 813-780-0021
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<br /> Butlding Departrnent
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<br /> I Date Recelv�d , � �P.hone-Contacf�for`•Permiltin�``" ' _ _ �
<br /> Owner's Na Ime s � (� �� Owrner Phone Plumber O I 3 " 7 7�: �` �QS, �_
<br /> Owner's Adl ress �� !�'�1=�'s�' • ' ' O,wner-Phone-Number _
<br /> � = ` ,' ,. �':
<br /> Fee Simple TltleholderName��� � ' Owner.Phone Numbe�`'_
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<br /> Fee Stmple.,Tiaehoiaer_�►aare:s � � _.
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<br /> JOB ADDRESS LOT#_ �
<br /> SUBDIVISI�N = � . PARCEL'ID# � - , ` - �
<br /> �' '(OBTAINED'FROIN=PROPERTYTAXNOTICE)'
<br /> WORK PRO�P_OSED ' � , =" �= NEW CONSTti � ° `'� ADD/AL"•T � SIGN '`Q � DEMOLISH - ,
<br /> � -,. B . > INSTALI. - �8' � =�REPAIR'• �_ ,. -. ,.. __ . � -
<br /> PROPOSED�:USE � [��� SFR [� COMM~' �Q OTHER` '
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<br /> TYPE OF C�NSTRUCTION.; ' Q ' `BLOCK�' 'Q', ';FRAME. -�] ;STEEL_ . Q ._. .
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<br /> DE3CRIPTION"OF WORK� `��i' ` (� ' ' L{S.Q/ . a�o`� X �. -
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<br /> BUILDING 51ZE;' •c�. ' _$Q.FOOTAGE.�� .. ; � „HEIGHT-. , . .
<br /> B ILDING "'-'�;;�`;.�' `"='''�^:
<br /> � � � ^ $"SDO. D� VALUATIOI�"aF'TOTAL"CONSTRUCTION . `� ,
<br /> QE�ECTRICAL $ AMP SERVIGE ` Q' PROGRESS ENERGY [� �;W.R.E.C. ,
<br /> QP�UMBING $ � :. _ ` � �-
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<br /> OMECHANICAL ' $ `VALUATION:OF,MECHANICAL;INSTALLATION � � r .
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<br /> QGAS _ Q, ,- ROOFING:��Q SP.ECIALTY' Q� OTHER� <` � �
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES. , , NO . � :
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<br /> BUILDER � COMPANY " ' r . .
<br /> SIGNATUtt� REGISTERED Y/ N. " �E CurtRE�' Y/_N;�.
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<br /> Address • ' ` Llcense# -
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<br /> ELECTRICU�W�.-3� , �.• �' COINPANY, . . . _�
<br /> SIGNATURE ' REGISTERED Y/ N FEE 6URREK '" Y:/N ' �
<br /> Addre�s ` . - ." , _ , r.License�#: . . � .
<br /> PLUMBER.� .. , ` - , COMPANY� ., � ` ' � � " _. '
<br /> SIGNATURE _ - ,�REG�S.7ertEp�- � ��,:.; �:Y/-�N': _ - .. �F.EE CURRFJ�•" , X/'N:�
<br /> Addre� ,� � ,Y . .' - • ..License#; _- . �
<br /> IWECHANICAI:.'_ ,. . .�. . . - . �; . .. =�: � : - . , : • :._ k. ,: • . _. . . . � :
<br /> :COMPI�NY., . <;; . ; ;;� ..:: „',;.; ,
<br /> SIGNATURE � . ' ' , - - ` " �� � Re�is.rEri��:�� ,>Y.:/:N- , ,�e:CuwtEn ._ Y �- •
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<br /> - Add�s�� . .f;. _ � r. ��. � „� ,,,-._ . , - . ` ' ' � ` . �s.:Ligense#-, " . . .,, t>. � _ -
<br /> OTHER � , . __., .. ., . .. . ' , . _COII,APANY.= _ -.. -, ,. � -... .. , - _F. , ., ,., � '
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<br /> SIQNATURE i . _ . - `' ` .REGISTERED Y/ N•.., �FE�'G.URREA .r�: ::Y.�I;N;.�.. - ' ` .
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<br /> � Addre� �.7-` �s:' z*�� - "�.' 'ry" � " ��L•icense'#
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<br /> RESIDEWTIAL..=b�::Attach:2';Plot�Plan's•.2`sets�of;8'ulldfn •Plan's;i�1`sefof�Ene ��Forms;�R=O-W�Pertriit.for�.ne con tnicUon;�. .
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<br /> - <Mlnimum7tens 410`workin =:d'a"'s"a�ter"s`utimiltaliilafe:>�R �uited onslte;-Conatrucdon>Plans;vSto"rmwa4e.r.�Plans w/:SIIt.Fence,instelled,. .
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<br /> , 6`Sanita <Feci itl� �&�1`+ u' ste���Si e� nrk�Pe t, "r:sutidivislansAa`e`�ro ectss.�::%;;,�,�:��';`:�'.�' . .- ` .
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<br /> CORA9NERCIAL �4ttach(3j c;oenplete`sets of'Bu7lding Plans plus a'Life Safety Page;(1)set of Energy Forms.R-0=W Permit for neW constructlon:
<br /> ! Minimum ten(10)worktng days after submittal date. Requlred onsite,ConsUucdan Plans,Stortnwater Plans w/Sllt Fence installad;, -, , -
<br /> � SanitaryqFadlides.�8�.1�dumpster..Site,Work.Permlt-for;�11`neinr'projQot's:All'commerdal.cequlrements mu�t meet.compllance
<br /> -SIGN PERA�IT AttacFi(2)sets o�fiEn"gineer ;Plans;�~..�=�r�{'�;..;:-~:`-::. _.��", �� _ , .Y: ' . � - _.
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<br /> ••`•PROPERTY._SUR�/EY required;fo��aII:NEW;conshuctlo�:.._,_�•
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<br /> Dlrectlon�•� :ky..�;_.�,��,��.;._ � , ...... ... _. _.. _ ._. ... �
<br /> FIII out epplicadon completely,
<br /> Ovuner&ContracMr sign back.of applfcatlon,notarized
<br /> If�over�52500,a�Notice,of:.Commencament is.�equfred.��(AfG-upgrade"s over s7500)_ _ e� , - -.
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<br /> '" Agent(�or ttie contractor)�6r`Powe�of Attoiney(fo�iFi'e'owner),would'be someone with no,tarized letter from owner autho�izing same-, .. -- .. - _
<br /> DVER'THE' �. ... .,. � : : .,:,..:......��on, �. . - -- - , -- , -•-
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<br /> �OUNT�R.PERMITTINti=='._=.::(Front ofiApplicatian=0nly)�� '.:, " - � ,
<br /> Reroofs if stiingles Sewers Service Upgredes AJC� Fences(Plot/Sunrey/Footage) _� .... - �� �� � - � - .. �-�
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<br /> Drivevriays-Not over Counter if ornpublic roadwiays:.needs ROW' -- - - � - - - -�- .-.. ••
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