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<br /> \ s��- saoozo City of Zephyrhills Permit Application � Fax-813-780-0021
<br /> - Building Department .
<br /> . - � . ,+
<br /> Date Receive , � phone Contact for Permitting - �/ �v2 — ��d`� �
<br /> t r. �. • n d
<br /> Owner's Na e v�/��% Owner Phone Number , ���'"' / !" ���
<br /> Owner's.�►d ress 373� � S //e C�i � Owner Phone Mumber
<br /> Fee Simple itleholder Name Owner Phone Idumber
<br /> Fee Slmple Titleholder Address
<br /> JOBADDRESS �/���,1 S� f°'�i dd1e� LOT# �
<br /> SUBDIVISIQIPI � PARCELID# �� � �/ db DD.� ��
<br /> I � • (OBTAINED FROM PROPERTY TAX NOTICE)
<br /> WORK PR�POSED . NEW CONSTR ADD/ALT 0 SIGN Q Q DEMOLISH
<br /> , B INSTALL REPAIR
<br /> PROP.OSE USE Q SFR Q COMM Q OTHER
<br /> TYPE`OF ONSTRUCTION - Q BLOCK - Q FRAME 0. $TEEL . Q
<br /> DESCRIP710Id'OF WORK M1 �/� l�17A/�I �OL.P�� oc L�d7�'1 D�'l�/��s, � TD/1I
<br /> BUILDINGISIZE SQ FOOTAGE� HEIGHT
<br /> Q UILDING $ � VALUATION-OF"TOTAL CONSTRUCTION
<br /> ELECTRICAL , $ AMP SERVICE �Q PROGRESS ENERGY Q W.R.E.C.
<br /> PLUMBING $
<br /> I MECHANICAL $ ��� , _\ VALUATION OF MECHANICAL INSTALLATION
<br /> ��
<br /> GAS Q ROOFING Q SPECIi4LTY 0 OTHER
<br /> FINISH FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO -
<br /> �BUILD COMPANY
<br /> SIGRIA URE REGISTERED Y/'N FEE CURRE� Y/N
<br /> A dress License#
<br /> ELECT.ICIAN � COMPAPIY
<br /> • SIGN�► URE �� REGISTERED Y/ N FEE CURRE� Y/N
<br /> A d�ess Cicense# �
<br /> .. PL:UM ER. COMPANY� � ' •
<br /> SIGN�TURE -REGISTERED� Y-/ N FEE GURRE� Y/N
<br /> �dress License#
<br /> ',. MEC ANICAL�� ,+7����� � � COMPANY �9-�R�S � � '¢�-��
<br /> '�SIGN TURE' G^-�/�" " REGISTERED Y/ N F.EE CURRE�, Y/N
<br /> aa�es��� t/��/i�-`1�e�il �, �—�-1/l�5, " �icense# C/�1�0��� �
<br /> ,� -.
<br /> OTH R= '• � COMPAMY �
<br /> SIGN� TURE"a •� " REGISTERED Y/ N FEE CURRE� Y/.N
<br /> Pddress�.>; ' •s' � • • ' License#
<br /> �� RES DENTIAL`,;;` Attacti°(2),PIof�Plans;:(2):sets of�B'uildirig'Plans,�_(1'-)`set'of Energy Forms;�R-O-W P.ermit,for new�construction, ,
<br /> - � -�, . _�.r�:��Minimum�tens,(;10)working;days-after_sutimittal�date. Required onsite;Constniction Plans,Stormwater Plans w/'Silt Fence installed,
<br /> �-• �� � � Sanitary1Facilities:&�;1.,dumpsteg;Site;Work-Permitfor;sutidivisions/large.p�ojects '
<br /> �. ;CO MERCIAL Attacfi''(2)'complefe`sets of'Builcling Plans plus a Life Safety Page;(1)�set.of Energy Forms.R-O-W Permit for new construction. -
<br /> - �_- -- Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence.installed,
<br /> �. Sanitary Facflitfes&1 dumpster,Site Work Permit foi�all'new projects.All commercial requirements must meet compliance
<br /> �-SIG,I PERMIT Attach(2)sets of;Engineergd Rlans:�° : � -
<br /> **'*PROPERTY SURVEY requlred for_aII.,NEW..construction.
<br /> "Directions: ,;�--,.--_;-_. . , . , .
<br /> ' Fill out applicalion completely.
<br /> Ovimer&ConVactor sign back of application,notarized
<br /> If over$2500,a Notice of Commencement is required. ,(A/C upgrades over$7500)
<br /> ...,.;,.: �.,_r,.:.:>;, ' ,
<br /> "' Agent(for`the contractor.)orPower"of Attomey(for'tFie ov(mer)would be someone with notarized letter from owner authorizing same
<br /> ..'OV RTHE COUNTER,PERMI.T,TING-.- .(copy.of-contract-required). .
<br /> �Re oofs if"shingles Sewers - -- Servicg Upgrades.A/C"�� �Fences(PIoUSurvey/Footage)
<br /> � ;�::.:r�.. :.:'�,' •
<br /> Driveways-Not over Counter if on'public'�oadways..needs ROW
<br /> .�. . _. �. .. ��_. -�.�...Y t ��-,
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