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813aeo-oozo City of Zephyrhills Permit Application Fax 813-780-0021
<br /> �. � Building Department
<br /> Date Recalved , .
<br /> - - ~ -Phone Contact?for Perm(tt(n :,' ', �
<br /> Owner'�Nfam� ���� ��I,s �f}-.h'�, Owner Phone Number
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<br /> Owner'�Ilddress � j gR re, � ' Owner•Phon��Number �
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<br /> Fee Sfmple Titleholder'Name � � " - � � Own.er Phone Number
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<br /> Fe.si�,pio rieienoiae�Aaa`re� .. °., ._..
<br /> JOB ADDRESS ,f �J' mI �� 6l,� e � /Q�l``j L , ���l�! LOT#
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<br /> SUBDIVISI�N �� - 'PARCEL'ID#' �J� �� '.07�" ,����"'���Q� "��f�
<br /> '(OBTAINED FROM PROPERTYTAX•NOTICE) '�
<br /> WORK PR i POSED , NEW CONSTR•:` � ADD/ALT [�' SIGN �[� Q;�: :DEMOLISH -
<br /> � B ' INSTALL � �.,-�REPAIR •�
<br /> PROPOSEQsUSE Q SFR �] COMM', � OTHER' � " ' �
<br /> TYPE OF CON3TRUCTION, -��[�]" "BCOCK�' `�Q '� �;FRAME �Q STEEL Q; � -
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<br /> DE3CRIPTIOPI°OF WORK / � �'j� �'�'�/�� � y�� � • � edyy� d/�le�f.�$
<br /> BUILDING gI IZE . - ' SQ;FOOTAGE -�_.. ..;HEIGHT:`:. - •� • -
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<br /> ,. QBUILDING . $ -yz„�--�::::.. ..-�r;,4�.. ._:.'` . - �
<br /> - VALUATION��`7'OTAL'CON$TRUCTION
<br /> Q E�ECTRICAL $ -� qMp � . t -- � �
<br /> l SERVICE Q' PROGRESS ENERGY '[�. W.R.E.C.
<br /> QPLUMBING $ ' �
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<br /> QMECHANICAL $ VALUAl'ION�OF MECHANICAL INSTALLATION -
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<br /> I��'$ Q • ROOFING.,,,Q SP.ECIALTY.� = OTHER '' �
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES. , NO
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<br /> BUILDER COMP/4Nlf " " �
<br /> SIGPIATURE REGISTERED Y/ N. �E Cu�n'�-: Y/.N.- - -
<br /> Addrea� , i Licens�e# ._
<br /> ELECTRICIAN,- - ., COMP�INY - '
<br /> SIGNATURE - ��y REGISTERED Y/ N F�etiRttEr: Y/N
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<br /> Address - , . , �.License#: ` • � �
<br /> PLUMBER , , C,OMP.ANY� �'
<br /> SIGNATURE ' � � � - _ •REGIS.TEREp� _,. ��Y.'/--,N=V� � •FEE.CURREI� - Y/N:
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<br /> �ddress .Wcense# -
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<br /> MECHANICAL '' ' _ - ,-.COMPANY�: � . �/f/�,S f'l.'OPr3/�I2�J-$�;.!�G �i✓C
<br /> SIGIVATURE ' � ��� � - '_ _ BEGISTEREDt ' ..Y;1•'N: , EEE'CURREP'; _. : Y:/N:';.`
<br /> Addre�a ��I �I�e�I����}/LL �� ��J� J , { Y ,. _.:Llcense# �/C}�D���'� 6.�
<br /> OTHER , , _... .- y _. _ - COMPAPIY ,. � . , � . . _.,: - . ,
<br /> SIGNAYURE. t - � - ''" - � ` � ' REGIS7ERED. , , Y/ N,:.. �RE�.GURRED ';Y:/�hl:-.. ,•; �
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<br /> /1Yd�A88 ;•i ,:vyr . . ., :j.) ,s, .. .. : • , . , ... „ . , . �
<br /> uCB�$8#�
<br /> R� �'D� .fy - _ Sr, _ -,¢::,.. ;,�,... _ _ .-s,:�i.:.,s;; ,.l�s� '�a•i�;•_ =.r:•w..' ,1 , .. . ..
<br /> ES EPITIAI:�: ^Attach;:(2)w_P.>.lot;Plans;.(2.):sets.of.Building P,._lans;':(1)"seti'of.?EnergyyEormsC�R-O=W.Pe[mit.for.new;:constriicf(on;-..
<br /> �' �-�rMlnimumctens(:10);worlting�;days�,a�ter<submlttaf�d"ate:��Requlredonsite;=Consliuotlon;Plans;�8to,'rmwater`Plansw/:SlltFenceinstalled,. _ _
<br /> - �`�_"SaMtaryFecJjitlesc8�r�rc�u�Pster,Slte�;W,nrkaPer.m�CfQr:sutidivi�lOns/Iarge�proJec�s�:'��.;'�t:a_,:�y��. +`- '.'•:' :, :�• � �
<br /> COMMERCIAL: Attach(3j�complete sets'of Bullding"Piens plus a Life Safety Pege;(1)set of Energy Forms.R-O-W Permit for new constiucUon:
<br /> , Mlnimum ten(10)working days'after submittal date. Requfred onsite,_ConsUuctlon Plans,Stormwater Plans w/Sllt Fence Installed, _
<br /> Sanicary,Fadltqes 81.,dumpster._Site-WorictP-ertnit for all new;projects:All'commerclal[Bqulrements�must meet compllance ,
<br /> SIGN:PERAAI7I ;4;�ROPERl'Y.SURVEY requ Ired for�all NEW,.coqsWcUon...� I ` ,
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<br /> Dlrecdons: i :e:i<.,�.;_: _.- - . .. .. . . _ __ --- - - � '
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<br /> FIII out applicatlon completely. ' ,
<br /> Ownar 8 Contraotor sign.badc of appl(caUon,notarized .
<br /> Ifiovec 5�500,�,Notice o£Comm�ncement la:requfred. (AIC upgradas,over 57500) , •
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<br /> " I\qent(for the cootractoF)"Gr:Power:of�Attoiriey(fo�`fhe�owner)would be someone with notarized letter from owner authorizing same
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<br /> 'OVER�THECOUNTER.PERMITTING�-=='<.(Front=of-ApplioafionOnly)���� _ -
<br /> Reroofs if shingles Sewrers Service Upgrades-,NC�-.._-�:Fences:(PloySurv_ey/Footage) .:- ,-. , :
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<br /> Drlveway�-Not over Counter if on public roadways.:needs��ROW
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