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a�a-78aoa�o City af Zephyrhills Permit Applic�tion Fax 813-780-U021
<br /> ?� Building Department ,
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<br /> Date Reca!Ied
<br /> i, � ° PhonetCantact•far Permlttin ' •
<br /> owner's Na�rne f`�'1( P11 SO� Owner Phane Na�mber d'�p ` '-� li
<br /> Owner's Address b�� �L S PT� � � Owner Phane Number � � 1 I'
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<br /> Fee Simple Tltlefiolder Name l � ` � Owner Phane Number �- � �
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<br /> Fee Simple�Itleholder Address °
<br /> JOB ADDRESS �O`5 � wC S � LOT# �� I
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<br /> SUBDIVISION �� - � PARCEL ID# � " 1
<br /> , (OBTAINED FROM PROPERTYTAX NOTICE�
<br /> WORK PRO OSED , a N6w coNsre� , - ADDlAi:T � SIGN' 0 �[� QEMOI.ISH i
<br /> �,e. INSTALL 8 • REPAIR �
<br /> PROPOSED�USE � � Q SFR_ Q COMM � �OTHEFt ' �
<br /> TYPE OF C�NSTRUCTION C]� 'BL.00K '' �[� FRAPJIE ' �[� STEEI. `CJ i
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<br /> DESGRIPTION OF WORK ._, Y-• t LrJC'�(,(il �f i1 C'<' �' i i
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<br /> BUI�DING SIZE' `� �' S�i#Y fOQTAGE /a.J � HEIGHT ��_,�� ';
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<br /> OBt�Ik,DI(VC, �$ ,� � . �� � • �
<br /> „1__.F „..•� �' ,
<br /> !,��� � VALUATiON"t3F TO'1'AL CQNSTRt7GT10N '
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<br /> QEC CTRICA� $ ' AMP$ERVICE Q �Pt20GRESS ENERGY � W.R.E.C. ��
<br /> QP��UMBINt'a . $ ' � �
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<br /> Q M�CFii4NiCAL $ ,, VALUATION OP,MEGHANICAL INS7ALlAT1!?N. C��j � ;
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<br /> QGAS [� RtaOFtNG Q _SPECIAI.'TY � OTHER- �
<br /> FINISHED F�OOR ELEVATIQNS FLOOD ZONE AREA QYES. NO �
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<br /> BUII.DEFt GOMPAi�lY'- . � F G.�-
<br /> SIGNATURE� REGISTERED Y/ N FEE CURRE� � Y/N� . i
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<br /> R,ddress � j � l��f �- � , �. L(Cense# � �
<br /> I E�ECTRICIAN� _ �GOMPANY` ,
<br /> SIGNATURE `" �G�s'rEtteo Y/ N FEE GURREK� 'Y/N i
<br /> • ��• _: ` ' - _ - � � < i
<br /> , Ad�ress ' . LEcense# � i
<br /> ', . , , . . . �
<br /> ( P�UMBER . , GQMPANY r
<br /> SIGNATURE " � r REGISTERED YJ>N FEE CURRE� " Y°/N �
<br /> Address , . . . license,# � , I
<br /> 1. ' .
<br /> MECHA3+IlCAL' , . , , " � CQMFANY
<br /> SIGNATURE{� - ' � � ' REGISTERED Y./ N . FEE CURRE�., Y/�N
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<br /> Addre�s � . ` - • ' �. . _ � ' � ' License#'
<br /> OTHER ' � ` , ` � . :;`CQMPANY � �
<br /> SiGNl�TURE ,. ' � �'�" � ` s' � ' ' j ' REGISTEREp� � Y/ N.. FEE CURREh Y/N '
<br /> � Addre ., , - . , _ ' �ic8T1S8#°�� " ♦� � .
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<br /> REStO�NTiAl:,�;= Attach�{2)PIot�P,laris�,{2)"sets�.of.:Buililing�`Flaits;'(1�.setiof�Enercjy�Faiiits;:R=O=Vit'Rerirtittcrnew�constructi6n, ,
<br /> r��.Minimum�,ken�(1,0);working�;days�after:subinittal�date.��.�Requlreil onsite;;ConstrucUon=Rlans;�Stonnwater"Plans�w/SOt Fence installed, i
<br /> i Sanitary FaclltUes;&°,1,dumpster�Sita Woric;iPermit�forsutidivisions/la►ge.p[ojects . _ ` "� � " - ° � "�
<br /> �OR�iMERCI��t. Attadi(8}-crimplete'sefs`of Sultiiing Plans ptus alife Safeiy Page:(1}set of Energy Forms.R-O W Permit for nerv canstnrcfion. _ �
<br /> � Minimum ten(10)working days after submittal date. Required onsite,Canstruc8an Pians,Stormwater Plans w/Silt Fence installed,
<br /> j, Sanitary Facilides&1 dumpster.Site Wark Permit for all new:projec�.All commercial requlrements must meet compliance •
<br /> SFGN PERMF51' Attach{2)se#s�of'Engineer.ed�Plaiis.,,.: .:;:•. :, " , ` ,
<br /> �I '•""PROPERTY SURVEY required for,all IVEW constructlon. � �
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<br /> i itFreclloris: �} .... _ .._..__ ._-1.t ari -
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<br /> Fiil out applicatlon completely.
<br /> Owner&'"Contractor sign back of appllcaUon,�otadzed '
<br /> if aver I�2500.a Natice of Commencement is required. {NG apgradss over S750qj ,
<br /> " Agent(for the contraotor)or Powe�'of Atlorriey(f�o�r`tFie owner)`would be�someone with�notarized letter from owner autharizing same
<br /> OVER'THS C�tiN'i'ER PERMITTINti .W_._(Fron#•of�APAllcation On{y}��
<br /> Reroafs if shi�gles Sewers T Service Upgrades A/G Fences(Plot/Survey/Foatage) �
<br /> Drivewa -Nct over Couater tf on public roaduvays:.needs ROW`
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