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a�sa o-oozo � City of Zephyrhills Permit Application Fax 813-780-OQ21
<br /> Bu[td'sng Department
<br /> e .
<br /> Data Received Q �f�. P,hane�Cantact far�Permiffin �� ��'�C �''� 3�
<br /> Ownes'�Name ,AhIC � L..�s�l�Sd Owner Phorte Numbec
<br /> Owner's Address C- 9 � � Owner Phone Number -�� � �
<br /> Fee Simpl�Tit eFiolder Name � � � �-Owner Phone Number � �
<br /> � .
<br /> Fe�Slmple Tit eholder.Address �
<br /> JOB ADpttE3 J��I�Sa ,�.}� ti LOT# �__,�
<br /> �uUBDIVISION �� � " PARCEL ID# i - �Ci`�:L'(--�(� - C)`�— �'�-�
<br /> y , �qBTA1NED FROM PROPERTY TAX NOTICE)
<br /> WORK PROP SED =�NEW COPISTR > ADD/ALT -�" SIGN� Q� Q DEMOLISH
<br /> '.e. INSTALL 8 �.�.REPAIR - ,
<br /> PROFCISED�U E Q SFR � COMM � �O'FkfEFt - .
<br /> TYPE OF CO ISTRUCTION Q - �BLOGK " �[] FRAME � STEEC Q _
<br /> DESCRIPTIO OF WOItK 1 �� �L, -2 .��S� �
<br /> BUILDING SIZE C�" �' � SQ�FOOTAGE ' , .,HEIGHT�.���,
<br /> BU3 DING $ �- r ���� VALUATiON'�1F,T0'fAi.COf�STRUG`t'fO1V Y `
<br /> QELE TR{CAL $ AMP SERVICE - Q PROGRE3S EPiERt'aY Q "W:R.E.C.
<br /> :�_.._�� D� �/"�-
<br /> �'T
<br /> [�PL MBING, $ ' (1�I�jfZ�V.fz �. '� /iEE¢/1� ✓ .
<br /> . «,�� �,�.,�,���G��'l�,
<br /> � Xz ✓`
<br /> QME FiAN1CAL $ ' - VA�UATtON OF:MECHANtCA�.INlSTALLATIOA! � _ ,
<br /> �=pa�1`"r'C�Gf --
<br /> QGA ��FtOOFiNG Q SPECIALTY Q = OTHER� ' � t�
<br /> FINISHED Fl OR ELEVATIONS ,�r� c1�-��, FLOOD ZONE AREA QYES NO ��j� i
<br /> �V�Q . � . � � ..
<br /> �
<br /> BU1I.DER COMPANY� ` .
<br /> SIGN�►TURE � REGI3TERED Y/ N FeE cuRrtE� Y/'N ,
<br /> Addrea� • Ltcense#'�! �
<br /> ELECTRiCI. : � `COMPANY - ,
<br /> SIGNATURE �` REGIS7ERED Y/ N FEE CURRE�`" Y/N
<br /> l�ddress '� . . � � � License# �— g �
<br /> �LU11IiBER '. �- COMPANY � .
<br /> SIGNA7URE' ' � � , REGISTERED Y,I�-N FEECURREA` Y�/N.
<br /> _ ' . � . . .
<br /> � - . _ _ , ,
<br /> :,� . � � ` ' ' �
<br /> Address �icense,#
<br /> MECFiANIC'. " - ' � C.OMP,�l�Y -
<br /> SIGNATURE ` ' � � � ` REGIS7ERED Y,/ N . ._l„' FEE CURRE�- Y IfN
<br /> Addrea' - � • , ... . ._ � � y ,_ _ Cicense#
<br /> 07HER � - � �" �� i� ��CQMPANY<_ � .
<br /> SIGNATURE -��_"`;`'% " " REGISTERED Y/ N,.. FEE CURRE�•� -. Y/N
<br /> Addre ,���.��; � � �= � liceiise# ,,e-CC-oS��t.GZ�. .� . _
<br /> �" . .> o. , .�..,...:_ ,�� � ' - �
<br /> RE3IDENTi . ;-..A�tacti(2),;P.,la#:P;lans;;:(2}set�:ofBultiling�PCans;(1}set of=Eneigy�Fviin§;`�R-0�W�'Perrril#far new ccnstruction,
<br /> -, t�.,�:;Minimum�tenr(1.Q)�worRing=days,atter,„submiEtal`daCe:,_:Requir"etl ansife;<Constiiic8on°Plans;Stormwa4e�`Plans w/SUt�Fence instailed,
<br /> �Ssnitary�actt4tis,s,;&�.1�dumpster�Slte�Worlc�P::ermit#orsubdivlslonsllarge:,proJects::_ =`:•;,, � '' '
<br /> COMMERCi A#tach(3 j�casnptete sef`s`'of 8ui[iiing Plan`s'pliss a Life$af�ty Page;(1}set af Energy Fatms.R-O W Permi#hcsr nex�construc�on.
<br /> Minimum ten(1Q)working days after submitMal date. Required onsite,CanstrucNon Plans,Stortnwater Plans w/Silt Fence installed,
<br /> Sanitary Factittles&1 dumpster.Stte Work Pemntt for ai)new;projecfs.AI!cammercfal requl�ements_must meet compllence ^ •
<br /> . SIGN PERMfI Attacti`(2j'sets�of Engineered�:Pians.,:;:-�����-- - => � -� , '
<br /> '"•'PROPERTY SURVEY reyuirednfor„all_IVEW canstnictian.,
<br /> . ., t." r
<br /> DlrecNons: "-����"� �- - -
<br /> Fill out�pplicadan completely.
<br /> Chnmer Contractos slgn baok af appitcaBon,notarized
<br /> if over ZS00,a Notic�of CommencemeM i�requ9red. (AlC upgrades over:67580) . -
<br /> ,�r-a-r•:,-�;,..,
<br /> '• Agent(�r the contractor)or Poweir of Attbmey'(for the ownerj would be someone with notarized letter irom owner authorizing same
<br /> DVERTHE OUNT.ER.P.,ERMIT77NG ;--�{Front�of•AppiicationA�ly}:;.::,...•.. ..
<br /> Reroafs lf sh ngles Sewers S'ervice Upgraiias'.A/C ��Fenc�s:(�'lot/Survey/Faotage)
<br /> . ..., ._.._ .� _- � - - . '`" ; ' - .:,
<br /> Drivew ya-Not aver Counter if on public roadwiays:'.needs ROW`'.; i,�� � �
<br /> � ,.1�., ,.r, .. �.., , . . ..
<br /> r,:n� _�. _.. H,.. .. � . ... .,.,....._ :,. ., .
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