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<br /> a�a- so-oazo City of�ephyrhills Permit Applicafiion Fax-813-780-0021
<br /> ' Buitciing Departmenf
<br /> Date Receive�l Phone C�ntact for Permitting �� f�� �� ����
<br /> Clwcnee'S:Na�e
<br /> t,.Q V( �,.} f.'� t3�nrnec Phon�4tum6er t� _� �U f.x'����
<br /> � _,•�...�., " � � �' �Q� � Q.'�`� � � l��i 1 5 50vrner Phane�Eurimber
<br /> ow���s�aa�«ss': t
<br /> . , ,. . �. �3 yl
<br /> Fee�impEe�itiei�aid�r Plame Owner Phone�Mumber
<br /> Fee Simple ittehulder Address ,
<br /> .DClB,a1¢DC3R. S��, �� i � f l.l,n J � 't'1� � � l� �(I I S �� �~��� � LOT# � }
<br /> SUBu�v�s�oN' . �)v�r OQ1C5 �1QSe. � � ,e��cE�::��� 0��a� --�f-�.I ��- 6(�=�b -,��`l'D
<br /> � � {QBTAINEp�IZ�Ni PROPERTY T�JC NOTICE)'
<br /> WORK;PRO,05ED NEW CONS7R ADD/ALT Q✓ �SIGN Q MOVE �J DEMO�(SH
<br /> � � � ' ' � � INSTALL � R�PAIR �
<br /> PROPOSIE USE , Q SFR Q COMM Q OTHER �
<br /> TYPE OF CONS7RUCTION � BLOCK � FRAME Q STEEL Q OTHER
<br /> ` ti a �� ��
<br /> �
<br /> �7�SCRIP,,�TION':OFaW018K; � � J �'� (e�t fl�� '�5 UQIe.S lo��� I��^tl�cl��,'i� Ce�S I� ��1 i 'I� t'� I�)a���
<br /> ::: .�.,.:..,,,. � ,
<br /> BUILDING�IZE+''. � >SB�I,_FOO�'AGE ���� HEIGHY
<br /> r B ILpING •��``� �-� '� �"'��� ;�.VALUATIONtOF�TOTAL,,CONSTRUCTION
<br /> � $ ���?�`��'���;'��f7'''�� , , , . .,
<br /> [� �LEQTRICAL. � � AMP SERVICE [� PROGRESS�NERGY Q W.R.E.G.
<br /> � Lt1MBiNG $ � - ����
<br /> �` � . . � �
<br /> Q ECHANICAL $ VALUAT}ON OF MECHANICAG INSTALLAfiON !� �
<br /> , . . . . ���v 1�
<br /> � . '� �
<br /> Q AS Q ROQFiNG Q SPECIALTY � OTHER C.�
<br /> FlMSFiED L�OR ELEVATlONS � � FLOOD ZONE AREA QYES ONO
<br /> i'-F4
<br /> �UILD�P� ' C�MPAfdY ,
<br /> SIGNA7U E REGISTERED Y/ N FEE CURRENT Y/�V
<br /> Address ' License# � . � �
<br /> ELEGTRIqIAN ' , , . , COMPANY - . .
<br /> SlGNATURE REGlSTERED Y I Rl �FEE CURRENT Y/N
<br /> a
<br /> Addr2ss � , � License# '
<br /> PLUMBEI� Cmiil9i'A,�VY . .
<br /> $IG11��1TI.IRE ' i2EGlSi'ERED Y/ N FEE CURRENT Y/N
<br /> Addr ss ' License# � - �
<br /> M�CFiRihil��AL COMPAIdY , . .
<br /> SIGNA7U�E REGISTERED Y/ N FEE CURRENT Y I N
<br /> Addr�ess License# '
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<br /> OTw�i�rif�i ... �i/� '�! �I ^� ;COMP�R►NY � � � ' .
<br /> �R
<br /> 'SIG9VA�Q'U�ZE,� ,C/�^��`�L{ � ��Q(j/`_ �REGIS'CER�D Y N FEE CU RENT Y/N
<br /> ! 2
<br /> A�lilress �.rD�'f,,,1 � S � F 3 3S`t 1 .�License# ��-������ I
<br /> ��SiDENt PAI.' • Attach;(2}Plot Pt�ns;(2}sets o��uilding Plans(1)set af Energy Forms;R-O-W Permit for new consfttacfion,
<br /> � , •Minimum ten(10)working days aft,er submittal date. Required onsife,�C�nstruction Plans,Stormwater'Plans.vu/Silt Fence ins#alled,,
<br /> Sanita'ry:Facii4f�es&9 dismpstet;SiCe Work Perrr�it for subdivlsiansllarge projects _
<br /> �QMNdE C(AL Attach(3)sets of�6uildirig Plans,(1)set of Energy Forms.R=0-W..Permit for new construcfion:
<br /> � Mlnimum ten(10)working iiays after submittal date. Required onsite,Constnackion Plans,Stormwafer Plans w/Silt Fence installed,
<br /> Sattitary Facitities&1 darripsfer.Site Wark Pertiilt fac a1i new pro�ects.AIE commercial�requ�rements must ineef compliance� � �
<br /> SiGPt F�i MIT Aftach(2)sets of Engineereii Plans. , , �
<br /> """*PRC�PERTY SURVEY''requir�d for eli NEW oonstruckion.
<br /> Direcfion : ' ' . ,
<br /> Fill a�at application comple#ely. '
<br /> flwnec&Contractar sign back of applicafion,natarfized
<br /> tf over$25Q0,a Ntatice of Commencemenf is required. (A/C upgrades over$5000)
<br /> '* Age�t(far the contractor)or Pawer of Attomey(for the owner}would 6e someone with notarized tetter frorr�owner authorizing same .
<br /> 'QVER THE COUNTER P'ERM17"P'ING (Fronk of Application Only) +�
<br /> Reroofs Sewers Service Upgrad�s A/C Fences(Plot/Survey/Footage) , ,�,
<br /> 'f; ;Uriv'ei�vays=Not.ove'r Coun#e'r,�if�on pu�lic roadways..needs ROW r''; � '`�'`��� � � , ' ,
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