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813-780-0020 City of Zephyrhills Permit Application Fax 813-780-0021
<br /> ,� , , Building Department
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<br /> Date Received ,. - , . �-p.hone-Contacttfor'Permtttin "." , I� ' `w�r m �
<br /> Owner'�Name r ; O,wner Phone Number J �
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<br /> B>.3- ��D- C�i�- �. .
<br /> Owrner'sAldress , �- '4 � � Owner-Phone�Number �" �
<br /> Fee Slmpld�Tltleholder:Name Owrner Phoni Number '. _ _ ,
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<br /> Fee Stmpl Titleholder l0.ddress . h» ' � '
<br /> JOBADD SS ��/I� �' + ` LOT# �
<br /> SUBDIVISI N � � PARCEL iD#� /��" � - -� .J `
<br /> , � . � ��`(08TAINED�FROM'PROPERTYTAX'NOTICE)-
<br /> WORK PR�POSED �: NEW CONSTR :��' ADD/AI:T Q SIGN Q Q""� DEMOLISH - ,
<br /> - ' B .r INSTAI:L & > REPAIR '• � -
<br /> PROPOSE _�USE Q�.� SFR '`�. COMM� Q OTHER" ' ""'" " " _
<br /> TYPE OF CONSTItUCT10N.. Q " ='BLOCK�",,.'Q, FRAME Q STEEL Qt.-.. - �, .
<br /> DESCRIP ON'�OF WORK ��- j /z`' '�.la ' ;�� , : c '. � � � , � ,
<br /> BtJILDING SIZE SQ,FOOTAGE .,.,� ;�.HEIGHT..: .;� : > : . , . - �
<br /> ---� QBUILDING $ <>;,�;��:,W:... .,,�.�, , ,. .._ ,,:'}� - "',...
<br /> = , �. VALUATIOId"O�TOTAL'CONSTRUCl'ION , _.
<br /> Q LECTRICAL $ • ANIP SERVIGE �Q � PR0C3RE$S ENERGY [�� W.R.E.C..
<br /> [�L•UMBING $= .: � ao � -
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<br /> Q ECHANICAL � � $ " " „ VALUATION�OF,MECH�4NICAL INS7'ALLATIOPI '��
<br /> - � . . :_ �� r �s�
<br /> Q S ,Q „ ROOFING;�:Q SPECIALTY Q OTHER�` _ � ` '
<br /> FIfVISHED LOOR ELEVATIONS FLOOD ZONE AREA �YES. NO
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<br /> BUILDER COMPANY � ` Y " ` � ' •
<br /> SIGNATUft REGISTERED Y/ N. , , FEe CURtte�' ,,, `'Y/.N .: , .
<br /> Addre s - . , License#` � � - �
<br /> ELECTRIC � �, ' COMPANY '� � .- . ' ,," -,
<br /> SIGNATUR - "' REGISTERED Y/ N F�euR�n Y/N ''
<br /> : " � � . ' � . ,.J. ' ' - • " �
<br /> Addr a� - t , �.Llcense#.,. � � � �. .
<br /> PLUMBER ,i., . � COMPANY: �:.�/���LA.v�,.JL: �rGsCi�..�or2-v��r/L���Ls-Sc5 ' °�,
<br /> SIGNATUR ` � /.-• - fREGI$TERED` �::,Y./�N:.; ,� :FEE.CURFt� : :�`Y/'N:� '
<br /> Addf6 Jr e3��'�(_a"�/�/ /d /�iJ �'- /L!_u' r ; .:.LIC6nS@.# �f'"�/.`./ ' i=:_ - .
<br /> •�_. <a _ ,:. . .._' �`. : , - , ,: . , . . .. • _ ,
<br /> MECHANIC. _ . ;` . , . . ...COMPANY. - - _ - , `
<br /> SIGNATUR ' - ' `� _ � �. Re�►S7Er�o . ,Y:/ N�, ,��;F�Cuw�n �-Y_/�N��>.�� '
<br /> Add - . , <, , � .,�, • , _ -, �. ,. - ,,License# . . ,-. _ �.f. � _
<br /> OTHER � -�° ;�:"- � .. � :}E, �. - .�CO�AP� __ _ - , � , , - , _ ,_ . , .
<br /> SIGNA7UR - �"', . .- - " - ` , . REGIS7ERED-� :Y/. N..::' - FE�`CURRE�- t.Y�/. , .
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<br /> /?lddre�s , - :�::,$�-��;�: - ... , _ ,. •• � . ' .. � - Lic�nse'# - � , : . ._ -
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<br /> " �;Si��':. y.'f-:�tiy��.,..:%'k:�.;:� �?��i�l`:."`=' � ., ,.
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<br /> RESIDENTI.,Y;;.=�;=°AttacFi;;_(2);,Plok Plans;�(2)`sets�of>BulldtngaPlans;.(1)set of;Eneig`'�F,orrnS;�R=0-1NcPerrri.itfor new`:con'struction;_;.�
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<br /> ;.�Mirif�um,:ten;(10);woritig_g;days:atte�;sutimittel�date.�Requitetl.onsfte;-Conslruadon�Plans;}Sfomiweter.Plans wl�Sllt Fence.tnstalled, -
<br /> ��n.tr. �:RY'w- , fi�. , � ... . .i � . � .
<br /> - - - � Sanitery;Faciliti,es;8�+1pd►��pster�Site��,lNorJc�Per.mit�o�subdiv_i'sforisflarge proJects�::,:,s.;��aw'::'� :r.:=�:��_��" .' . _ : . , „ , .
<br /> �CORANIERC AL Attach(3j`isomplete'sefs of Buliding Plans plus a Life Safety Page;(1)set of Energy Forms.-R-O-W Permit for new constniction.
<br /> Minimum ten(10)working days aRer submittal date. Requlred onslte,,Construcdon Plans,Stormwater Plans w!Sllt Fence ins�lled;
<br /> Sanitary Facilides 8�.:1.dumRster SIte,Work.Peemlt.for�all:neW'project's:All;commercial:cequlremenls-must meet compllance'
<br /> SIGN:PE IT� Attacfi"(2)'sets'of"Engineer,ed�Pla[is:��mi:,>„�`r�{�- .,.: . : . - � • T ' .
<br /> ••••PROP_ERT..Y.�SIiRVEY required;fqr;,�II�NEW:oonstruc�on,.:._,, - -- - , � .
<br /> Q�f8C�0118:1 !;`; , m_ __.., _ ._ __ i. _ . ----• .._. - ' , tii�-;�;x3 - •`_u:
<br /> Fill out applicaUon complately. „ , ... . , :,, � � '` .. `'.�s:: �,:i•• , _ �1., � ,
<br /> Owner&Contractor sign.back of aPpltcatlon,notadzed: ,.. __, .�. •;t.i•.. :;:'i 1 ,�c`�'.- ,-:; ^�.'�,"'`;`. :`�:'�- ' _ .. .
<br /> If'over�S2500,a:Notic,e.of:Comm�ncement la requl[e�l:"'(AlGupgrades;ove[57500).,_ �_ = r .:.�.�_..._. ,. �� -�-``�� "' - ,'�;;��4' �,
<br /> I -;�i<:.;'7}�,T:`l,i,`i"it�; : '_ ";:i_::�'.���L�`�:I-. _ "_ s„'ti+,".:�,:� .. - . - ' ,;;a.; ' '.:\: '�L� '
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<br /> '• Agent(for the co�tracto�),o7:Po`inre�of AttameyG(for�,tlie,owneF)w+ould lie someone with nota�ized letter fromiowner autho�liing�same�•••��-'���,"' - _
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<br /> 'OVER THE�OUNTER�iP..ERMITTING�'=-;��(Front�of Applica4ion Only)��' = __ - : _ - .—
<br /> Reroofs If s �ingles Sewers Service Upgredes A/C _ Fences..(Plot/Survey,/Footage) - � -• . -
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<br /> Drive ays-Not over Counter if on public roadwejis.:needs ROW . . - - ,_
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