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<br /> 813-780-0020 City of Zephyrhills Permit Application Fax 813-780-0021
<br /> � Bullding Department
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<br /> Date Rece ved � Phone=Contsct'for`Perm(ttin �� � - • ' -
<br /> Owner's NI me � � �L�l2 S � �'O �6�. ZC�' Owner Phone Number L�' �o�"" 9� ,'
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<br /> Owner's�tldrasa /d G��'/'l.e� ��� � /S Owner•Phone-Number "
<br /> F�e Simpl�, TlNeholder Nam��� . � !� - ' " Qwner:Phone Number ' _ ,
<br /> � `�? .,, . .
<br /> Fee Simplo Tltleholder��4ddeess -., • - , �.
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<br /> JOB ADDRIESS p T..�p2 � o��� �,�, �/cj�/L�S LOT# �
<br /> susoivisiQN � _ . - ,� . ,PARCEL.ID# I cJ- o?�v''.�l� D l�D�lrlfOC)O D� � -
<br /> ' �(OBTAINED'PROM PROPERTY TAX NOTICE)_ •-
<br /> WORK PR I P_OSEC . NEW CONS7R � ADD/ALT Q �SIGN -'C] `' Q"� DEMOLISH -
<br /> � ; � B `- INSTALL - :REPAIR- • , - _
<br /> PROPOSE II�USE. Q° 'SFR Q COAAM`� 'Q OTHER - ; ' . .
<br /> TYPE OF C�NSTRUCTION. � �Q -BCOCK�' Q',_� FRAME Q ;STEEL ,Q�.
<br /> � ti
<br /> DESCRIPTI� W OF WORK ' �'GPS���C� �l�7�JS�" e f�j�L� o� ��/� ��!L�pZ o� Cpr!'1 O/1J�
<br /> BUILDINGSIZE..^' . - SQ.FOOTAGE:.� . . :;HEIGH�-. ...; .
<br /> i - - � -
<br /> OB�ILDING $ w=:;�;��.,r, v.:r_���_ .. . .. ,
<br /> II , ; � , �VALUATION�F TOTAL'GON§TRUC710N ,
<br /> QELIECTRICAL $. AMP SERVICE 10 PROGRESS ENERGY Q �W.R.E.C. -
<br /> QPLI MBING $. , . - ,. , . ,. .. - � -/
<br /> QM CHANICAL $ 'VALUAT'ION,OF.MECHANICAL,INSTALLATION � �� ��
<br /> � , ��9� - � - - , . .
<br /> Q I , Q -ROOFING. ,Q SPECIALTY•:Q- OTHER• ' � �Q�rV
<br /> FINISHED F OOR ELEVATIONS , FLOOD ZONE AREA QYES. NO (� L
<br /> . . . ,..'
<br /> BUILDER COkIPANY ° � �
<br /> SIGNATUPtE REGISTERED Y/ N. ' � FEE CURREA: :,: �.Y/.N. .:; , , ; �•
<br /> Address � " Llcense#' � �
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<br /> ELECTRICI _ - � �' CO{dIPANIf � ` '
<br /> SIGNATURE ' y5M REGISTERED Y/ N FEE GURREK -�.Y7'N� ,
<br /> Address . .'License'#.: � ` �
<br /> PLUINBER , . , COMPANY� -� - � � " ' •
<br /> SIGNATURE ' ' - ., ,. ;REGIS.TERED-. ,_ 'i�.-,��.:Y`/-.N� -- � .FEE:CURrtEt��''- •'Y/N:.,-;
<br /> � ...
<br /> Address - - _ . - .. ' � , ., ..Llcense# �. _
<br /> MECHANICAL'� ' ' ? ` , _,COMPANY: �7��,/1 � /y� /4�/l�2 - � - '
<br /> SIGNATURE G�� � RE�tsrEr��;; _. �Y:/'N- , .�e cuw�n� _ >„Y:1-N:<_:,,: , . .
<br /> _I. :� - _ � _ , ,.. _- . -
<br /> Addreas�{ ���� �I�� ` �/LL� ` ' . ,. ;, :License# ' ��: . -
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<br /> OTHER �.:� � , ..' . � ' COIy�PANY. � , : _ .
<br /> SI(3NATURE"I. ' .- ' , ' - ' .� � , , �REGIS7ERED. , , -.Y/,. N� : ,=�EyCUR�n., -YJ.N;: _: - , -
<br /> �►ddPess - _ ' - ��:::f':' _ , r`. ., :`�, -- . " .,... .;.4._ - ., � • `License#` ,. ,
<br /> ,�- .::\� _;i,l` c'sF�:"F.�- : .�1'.c.)�. e�.i;k�,3. :a:,t- ,�.{_ .. - - .. v � . •
<br /> RESIDEYV �'�A1tacFi.'�2� P.,lot�Plan§�. ,sets:of,9ull`din!Plans�`��1�`setofEne �Forms;�R=O-VU,iPermlt:fo'�.n `,constniction;.. - .
<br /> . T�°►�'��� - ,...�.)�. _. ���2�)., .9„. �,� ),�.. r9Y._ _... ... ,. �!'.. - - , :•,
<br /> - � . . . . 4 ., t' .n��.,. . 'Y�:-''s."'.
<br /> � � ;�i;;,Mlnimumi.ten:(+'�IQ�worltin,g<,aeys�;aite'r:;s`uti�i'iittel�8afe:�RequiFed onslfe;-Constnicdon�Plans,',-StoRnwate['Plans:w�-SIIt Fence installed,
<br /> - - - .�. `.SaMt�iy Facjlides&��1,�u�pster,S(terWo'raksPer,mit;(or sutidivislGn&/large:projec�s';::;a�;:�:�::�'-`':'= ` , ' . --
<br /> COMMERCIAL Attach(3j vomplete sets'of Buliding Plans plus e Life Sefeljr Pege;(1 j set of Energy Fortns.R-O-W Permit for neW construcUon.
<br /> � MiNmum ten(10)working days'after submittal date. Required onslte,Construcflon Plans,Stormwater Plans w/Silt Fence installed,, .
<br /> Sanitary Fadlides 81.,dumpster...Site.Work,Permit for,�.I,IKnew�project's:All;gommerdal.requirements must meet_compilance' .
<br /> SIGN PEItMlT Attacti(2)sets=o7�Engii�eered;Pla[js:(�::�,��'�-:'�`. .. . , .' - '. -
<br /> ""PROPERTY_.SURVEYreguired-for aII,NEW:conshuctlo�i::.. _ - _ _ ;:,,; -• _ .
<br /> Dlrectlons• �� . :v,-.�:=:�,r, '.,. . . .. ._. . _ _ . .
<br /> Flll;out appficadon completely.
<br /> Owner 8 °ntraetor sign back of applfcaUon,notarized
<br /> If over S� 0,a•Notice of.Commencement is required. (AIC upgrades over 57500),„ � _
<br /> �.;:;5:�3:"�}i"`:AF4t;r'-,`=.,. .-�...._........... ...._ _.. .. ,. .. _. . -.... . __ _ ,
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<br /> Agent(for e contractor)'Or:Power of'Attortiey(forthe_oamer)would be someone with,notarized letter from owner autho�izing same @
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<br /> .DVER THE-CO NTER:PERMITTINi3•=-==,"�(Front<of=Application•Only)� ' Z
<br /> Reroofs lf shingli s _Sewers Service Upgredes A/C : Fences.(PIoUSuryey/Footag,e) . _,. ._ o
<br /> Driveways�INot over Counter if on pr�blic roadways..needs ROW� ,` '
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