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- 813-7$0-002o City of Zephyrhills Permit�4pplication Fax-813-780-002't
<br /> 4� Building Department .
<br /> Date Rec�ivec�l, Fhone Cootact for Permftting " �� � ���`` — �v�./ .
<br /> Owr�er's Nam /��Nl��RJ!��� �i�� Owner Phane Number l✓"�'—6��� /l�
<br /> Owner's.Add ss ���` ��� �, ����-5 � Owner Phone Pdumber �— �
<br /> Fee Simple Titleholder Wame . � Ouvner Phone Number �! �
<br /> �
<br /> Fee Simple T tlehold+�r Address
<br /> JOB�DDRE S ���v `�� ��� �-�/�`� f"�- � LOT# ���
<br /> S�B��v�s�� . � , �� p�����a# 11 � �l d�f� l.� �oo �tCd
<br /> (OBTAIPIED FROM PROPBRTY TAX NOTICE)
<br /> WORK PROPd3SED NEW COtvSTR AC}DlALT � SIGN Q Q DEMQLISK
<br /> e � WSTALL � REPAIR
<br /> " PROP.t3SED �SE Q •SFR Q C{}MM [� OTHER '
<br /> TYPE'OF CO STRUGTION Q BLOCK • Q FRAME C� S.TE�L . ,�� ;
<br /> � � /� /
<br /> DESCRIPTIO�`OF WORK ES. �� C��Yji� G bGL� Id"J1.� t�'lJl1 /�R/�� � � /iN
<br /> BUiLDING'SI E � �. SQ FOOTAGE�_,� HEIGHT �__�
<br /> Og�Ld'�� �_� VALU/�TtOtV°OF TOTAL CONSTRUCTiON
<br /> QEL C.T:RtCA� ,� � AiVIP SEi2VICE ED Pf30GRESS ENEi2GY Q W.R.E.C.
<br /> QPL MB1�1G ���
<br /> QM CHAI�ICAL $ �s���' ��� VA�UAT101U OF MECHfW1GAL INSTALLATtOiV
<br /> �
<br /> QG S Q E200FING Q SPEGIAG'fY � OTHEFt �
<br /> FINISHED.F OOR ELEVATIONS �+_� FLOOD ZONE AREA QYES NO
<br /> BUILDER COMPANY -
<br /> SIGWATURE REGIS7ERED Y/ N FEE GURRE� Y/N
<br /> Addres ' License# �� �
<br /> EtECT121C1. COrilIPANY �
<br /> SIGNATURE � REGISTERED Y/ N FEE CURREP Y/N
<br /> Addres � Lioense.# �� ` I `
<br /> PLUM�ER. COMPANY °
<br /> SIGNi�7URE' �REGISTERED Y.�/ N FEE GURRE� Y/N
<br /> �4ddres Liaense•#"�� �
<br /> �+ nrt�cMiwic � ��.y� � cat�P,ari�r �4 �''S t'!'� fa�l� S��f� ���
<br /> SIGNATURE REGIS7ERED ,- Y/.N FEE CURRE� Y/N
<br /> •., , , '. �
<br /> �;aa�es ��= , �f��/i�l en1 ; ��lLLS `33 SL License# �e� ����O �
<br /> .if,•`.'r '• ' " .
<br /> OTNER�� ; � � � � CORfIPAt�iiY
<br /> ;'SIGNATURE 5:� •< --� " �• ' � REGISTEREp Y7 N FEE CURREri Y./N
<br /> �4ddres ; <s; � - ' � = ' ' License# �� �
<br /> .,f.:� �,.,. ....pt .v[r" '_. "f' : <:;i'} r .t-. .. �.'rc.i � .. `. :.:" .
<br /> -:RESIDENTi ::._ Attach;.(2);�'Iat�Ftans;(2):seCs-ofhBuili�3ng=Plans;(1•}set'of°EneFgy Forms;R,Q-W.Pefirilt.for,new:constntctian,
<br /> , ._ %;.r,�;.;:..,r;.;, °�Minimum;�ten;,(=1Q)working;days afte�;§u6mittal:date. Required`onsite;'Construction Plans,Stormwater Plans w/;Silt Fence installed,
<br /> Sarilta.ry.�FasiliBes>&���;dumpster;Site;Work�Peimit'for`sutidivasions/lacge:.projecEs��� `
<br /> 4 s F..�4,r_�2^,.a f.`:..rt,*:..�...:..
<br /> s, C�MMERGI Attach�(2}�comptete sets ofBuitding Ptans plus a Life Safety Page;(1}set of Energy Forms.R-O-W Permit for new canstructian,
<br /> . Minimum ten(10)working days after submittal date. Required ansite,Constructlon Plans,Stormwrater Plans w/Silt Fence�installed,
<br /> - Sanitary Facilitles&1 dumps#er.Site 4Work Perm3t foc.atl new projects.Atl commercial requirementsmust meet compliance , _
<br /> „,�$IGN�pERM T AttacFi(2f sets of�EngineerQd Rlans:�+ , '
<br /> *'""PROPERTY$URVEY rgquired for_aII.NEW cdnstruction. , , ,
<br /> bi�ect'ions: ,. _ ���',. .. , __
<br /> � FIII'out pplicadon completely. �
<br /> �Ouirrter Gontractor sign back of application,natarized
<br /> if over 2500;a Notice of.Commenceiment is required. (AIC upgr,ac�es.over$7500)
<br /> .,�. �s''--°>"
<br /> Agent(orUie�contractor.)�orPower of�Attcimey{for ttie:ovjrner}_wouid be sameone with notarized tetter ftom awner authorizing same
<br /> � ,`.OVER.THE- OUNTER.P�RMIf'RING .. .�`:(copy;of�contca'e4required), , "
<br /> =Re�oofs if shi gles Sewers�r Serviae Upgi�des A/C= � ;Fences(i?lot/Survey/Footage)
<br /> _ ��.�,.. ., . .. r , . . _ .. ..,. �
<br /> Drivew ys-Not over Countierif on public�roadways:.needs ROW :
<br /> _ �_. _. . ._
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