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<br /> 813�780-0020 City of Zephyrhills Permit Application Fax 813-780-0021
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<br /> Date Received ' 2 . 26(� — 3 3 `f�
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<br /> Owner's Na I e' �( � Owner Phone Number
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<br /> Owner's Address � C�C < <�"'Ow�P�ne Number
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<br /> Fee Simple Tltleholder.Name • Owner Phone Number � �
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<br /> Fee Stmple Titleholder Address. ^ !
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<br /> SUBDIVISION - � PARCEL ID# � , -1' Z,� "2I " OO j,j�- CO Z ^ �¢� �
<br /> , - , . (OBTAINED FROM PROPERTY TAX NOTICE) i
<br /> WORK PROPOSED .^NEW CONSTR , ADD/ALT � Q SIGN� 'Q � �Q DEMOLISH �
<br /> .B. INSTALL 8 ;- REPAIR ,. �
<br /> PROPOSED?.I SE Q SFR Q `COMM Q OTHER _ �
<br /> TYPE OF CO STRUCTION - Q�' ' BLOCK ' Q� FRAME � .Q STEEL 'Q _
<br /> DESCRIPTION OF WOFtK-' •� /'�G�f"" v��t ��,✓1� 3V I � L� l� � �(�G�,1
<br /> BUILDINGS�E � , SQ�FOOTAGE " I� ,HEIGHT� . _ �
<br /> OBU�LDING $ VALUATION;OF TOTAL CONSTRUCTION I �
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<br /> QEL CTRICAL $ " AMP SERVICE Q 'PRO'GRESS ENERGY Q W.R.E.C. �
<br /> OPL MBING- $ '
<br /> QM CHANICAL $ � VALUATIQN OF�MECHANICAL INSl'ALWTION ` � ��
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<br /> QGA Q ROOFING Q SPECIALTY; Q OTHER� � ��
<br /> FINISHED FLIOOR ELEVATIONS FLOOD ZONE AREA ��YES NO
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<br /> SIGNATURE REGISTERED Y/ N FeE CUR�n Y/N�� .
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<br />� PLUMBER ` . COMPQNY.,�. . , . � -
<br /> SIGNATURE` ; �REGISTERED Y./.-N.. �:FEE CURRE� Y-/N. �
<br /> Address ` License�# . . .. ' � � „
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<br /> MECHAWIC�` - , f .` , COMP�INY � , '
<br /> SIGNATURE•j � ' � ` REGISTERED Y,/ N FEE�CURREP Y/•N '
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<br /> RESIDENTI, �?_,> rAttacfi�(2)„Plot%Plans;-.:(2)sefs"iof+Building;�Plans;(4)'sef of=Energy�Foirns;,R
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