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j 813-� eo-ooZa City of�ephyrhills Permit Application Fax 813-Tso-ao2�
<br /> , 8ullding Department
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<br /> Date Recelve,d� .-: phane=Contact�far�ermlttin ' –
<br /> 4wner's Na II Qwner Phone Number
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<br /> Owner's Add ess �-! � ��• � Owner PhoneNumber � �
<br /> Fee Simple tleholder Name � Owner Phane Number �� �
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<br /> Fee Stmple T tleliolder Addr�asa � •
<br /> JOB ADDRE S LOT# �__,�
<br /> SUBDIVISIO �— � P�ARCEL.ID# � " �U '. f°-'C��¢. t7~ (� �� —�� �
<br /> , (OBTAINED FROM PROPERTY,TAX NOTICE)
<br /> WORK PRO G1SfD� •,NEW CONSTR � ADDIALT � SIGN' `[� Q DEMOI.tSH
<br /> �;��. INSTAI.L �', REPAIR
<br /> Pl20Pt}SEDrI $E . ' [� SFR Q 'COMM C� �OTHEF2 �
<br /> TYPE OF C0� STRUCTION Q ' •�BLOCK `" � FRAME [�� STEEI. Q
<br /> DESCRIPTI N OF WORK, . . c.�-�J� d Z�� �� {��-� ��� �� �
<br /> BUILDING SiZE �^' � SQ'FOOT/lGE ` � , '.HEIGHT��C��
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<br /> �����d���'' $ C� VALUATION:`�7F TOTAL CONSTRUCl'ION , `
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<br /> QEt.ECTRIGAL � � AMP SERVICE. 0 PRfJGRESS ENERGY Q W.R.E.G.
<br /> QP,i�l3MBtNC3 $ -, -
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<br /> QMi CHANICAL $ ' VALUATION OF.MECtiANIGAI IHISTALIATIt}N. ;
<br /> Q�S Q . ROOFING Q SPECIA�.TY �� OTHEFL
<br /> FINI$HED FILOOR ELEVATI4NS L� FLOOD ZONE AREA QYES ,NO f
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<br /> BUILDER ��-Z� COMPAfiIY'� f t. �3Z3 ft1
<br /> SIGNAI'UR �' REGISTERED Y/ N FEE CURRE� Y'/N
<br /> Address � � Llcense# �� �
<br /> �tECTRICIAN . .'COMPIINY - , `
<br /> SIGWATUR,� `� REGISTERED Y/ N FEE CURRE�'' Y/N ,
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<br /> l�,ddre s . License#
<br /> PLt1N18ER I~_ COMP..ANY �
<br /> SIGNATUR ` ` REGISTEREp Y./;N FEE CURRE�' Y�/N.
<br /> Addre ' Ucense.# � .�- :' = 1�
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<br /> MECHANIC�41:' ' � ' � f COM.P.At�tY
<br /> SI(3NATUR�� - gEGIS7eiiEp Y,/ N ; FEE CURRE� Y,/N
<br /> Address` z , . � �. � � .� ' = License# �� I _
<br /> OTtiER I: _,, ` . . ` .'COMPAI�iY , Y . � .
<br /> SIGNATUtt� "�� � •` ' - ' �' REGI$TERED Y/ N..- FEE CURREk Y/N ,
<br /> Address, , ,. ^ . . , License# � ��
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<br /> REStRENTIAL,;'- ,�Attacti`{2),PlottPlaris;�(2)set`s`:af=8uilding�Plaiis;'{'I)setof'Erisrgy=Faims;:F2=0�W`Peris►itfornewconstrqc�an, _ "
<br /> , Minimumsten�(1,0).;wo,rlcingrdays,'after,_subirittital'date.:-R'�quired onslte,:Constru'ctlon Flans;`Stannwater Plans w/Silt Fence instalied,
<br /> x� ��.:-Sanitary Fac{IIUes,.&�.1;dumpste,r,,Slt�-Wa�Ic;Permihfcr subdivislo`ns/largeEprnJects_. .:, ,_ � : , ',
<br /> -._COMN9ER_,IAL Attach{3)eomplete'sets of'8yilding"P1ans�plus a Cife�Safety�Rage;(1}se#of Energy Fotms.Ft-O-W Permlt far neuv construGtiao.-
<br /> � Mln(mum ten(10)working days efter submittal date. Required onsite,Construcdon Plans,Stormwater Plans w/Silt Fence installed,
<br /> wanitary Faciti8es 8!dumpster.Site Wosk Permit for all new>proJec�::All commerclal requlrements.must meet compllance
<br /> 51f3N PER�tiT Attact►'(2)sets of�Eng,i'n�e[ed:.Pians:;.� ;�-=- ��_ _ .. � ` -
<br /> II ""'•PROPERTY SURVEY reguired for,all NEW construction.. .. „ ,
<br /> Dirpations'i �..',�.,w_:}_.-. : . . _ .
<br /> FIII ou�applicadon completely.
<br /> t�wns�&Cantractor sign back of appitca�on,no�dzed �
<br /> If ove �52500,a Nottce of Commencement is reqWred. (AIC upgrades over S7S00}
<br /> .Y���C.�;
<br /> " Agent��(for the'contractcir)or Pbwer ofAttbmey"(for"ttie owner)"would be someune with nota�ized letter from owner authorizing same
<br /> QVEFt'TH �COUNTER:PERMITtING�- •�- (Front•af-Applfcation•t3nly}•� •
<br /> Reroafs if s ingles Sewers Service Upgrades A/C Fences(PlodSurvey/Faotage) �
<br /> Drive) aya-Nat over Caunter if on pubiic roadways.:need's ROW
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