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813-�80-0020 City af ZephyrhilOs Permit Application Fax-813-780-Oq21
<br /> , Building Degartment
<br /> � `
<br /> Date Received � . Phone�Contact for Farmittto S C� ��� — ��f�
<br /> Owner's Nam C/�� e/'�S Owner Pbone Nunfber ��^�� ��J°"�� . �
<br /> Owner's Add ss ����� •- �r'Q/J''� !�.� �OSG., .p� Owner Phone Number �� �
<br /> Fee Slmple T tleholder Name � � � Owner Phone Number �� �
<br /> �;� .
<br /> Fee 3lmple T leholder Address '
<br /> JOB ADDRE S ✓/�� / � * � b S� [.F' LOT# �_�
<br /> SUBDiViSlO �(��'��dL? `t�� � PARCEI.ID# �!� �� �f ���� �L��� �'Z��
<br /> _ (OBTAINED FROM PROPERTX TAX NOTICE)
<br /> WORK PROP QSED ° NEw CONSTR ADDlAti.T -�,� SIGN -0 [� DEMOI.ISH
<br /> I. �:e. INSTALL �- REPAIR
<br /> PROPQSED:t9SE Q SF12 � CQMM � OTHER
<br /> TYPE OF CO STRUCTION - Q � BLOCK ' [� FRAME [,� 'STEEI: Q _
<br /> DESCRtPTId OF WORK F . ����'" L� Q-�f,.? �nr.v�n}��ie ansl � . �/ /��
<br /> BUlLD1NG SlZE �� �� SQ fOOTAGf C.�� . . .MEIGHT
<br /> 0������C' �_�� VALt3ATtOiV'OF TOTAL CONSTRI`1C'i'ION '
<br /> QE CTRiCAI $�'�� � AMP SERVICE Q PRt�GREBS ENEFtGY Q W.R.E.C.
<br /> L.
<br /> QP� MBtNG r$
<br /> ,:l��
<br /> OME HANlCAL
<br /> �' VAlUAT10N QF MEGHANICAL lN81'ALLATlON
<br /> � /�DD, h��- - .
<br /> QGA Q FtC}QFiNG Q SPEGIALTY � , OTHER•
<br /> FINISHED FL OR EI.EVATIQNS ��� FLOOD ZONE AREA QYE$ NO . `
<br /> BUIl.DER COMPANY' , -
<br /> SIGNATURE REGIBTEREb Y/ N FEE CURRE� Y/N ,
<br /> Addrss� � Ltcense# � ��
<br /> EI.ECTRICIAN;- , Ct1MPAFlY � .
<br /> SIGNA7URE '' REGI3TERED Y/ N FEE CURREk `Y/N
<br /> Addre38 ' `. , .. . LIC8t1Se#.� �
<br /> PI.UMBER ' � COMPAAIY ' , ° .
<br /> SIGNA7URE' ' � ,ReGIST�tE� Y./,.N ,FEE CURREA Y/N
<br /> Address - License,# � - � �
<br /> MECNAPIIC . . �'��� ` `��� ; COMPANIf Rl�R� l'13 tt�t1E G��'"%U'.-=1"v�
<br /> SIGNATURE• RE��sTEREo , , Y,/ N . ,FEE CURRE� Y./�N .
<br /> Address `•• � �'��I �/Cc�v "- • . llcense# ���D��.g`Z���
<br /> • -.. ' . .. ;: _ , , , , � . ,.
<br /> OTHER ,`` � ` `:GOMPANY �
<br /> SIGNATURE ° �-' '�•' � - •� " �' � REGISTERED � ' Y/ N�_ FeE cuR�n Y[N
<br /> Address - ,�° -'. ,r� ' `. ` . - � Llcetise# � �
<br /> .� ..�.......:.. ... � �. . .; .. ,.;
<br /> RESIDENTI,,�; �Attach:{2},Rtct%P,laris;,(2)sets:of+8ullding'Ptans;(.'!}sef of=Eriergy=Fa'rms�R=O=W'Perrtilt#or new canstruct�ori,
<br /> ,Minimum,titen;,(:1A);wortcing�days;after subinittal date:-;R'equlred onslte;;ConetiuoNon;Plans;Stormwater Plans�w%Silt Fencs installed,
<br /> �� �8anffery Facilfdes;&:1:dumpste.r,�Site•Wor1c;P,ermit,for subdivislons/large'proJects; _..' ...�,. ,.' ' � - ' -
<br /> COMMERCI ' Attach{3)i�mplete`s`s#s''of Bulldliig�Flaris pliis a I.tfe�Saft�ty!'age;('f}set o#Energy Fotms.R-O{1V Permit tar new construc�tion.
<br /> Minimum ten(10)wo�icing days afker submittal dake. Required onsite,CansUucBon Plans,Stortnwater Plans w/Silt Fence installed,
<br /> Sanitary Facilitles&1 dumpster.Slte Work Permit for all new=proJects:All commercial requlrements�muat meet campliance
<br /> Sl�N PERMI Attact�{2jseis af Eng,i'neeced.Plans., - �;:�. _ . .
<br /> """PROPERTY BURVEY repuired for all_NEW canstructibn.. �
<br /> Dlreettons: . . . . - .. `
<br /> Flll out a�plicadon completely.
<br /> Gwner&Contractor slgn back of applicadon,notarized
<br /> if aver �00,a Nottce af Cammencement Is reqaired. {AtC upgr�de�over 57500}
<br /> i. `s.`.`...4i'l�'r�. -. .._ .. '
<br /> " Agent(fa the contractor)`ar`Powe�of Attomey(fb�tfie owner)wouid be someone wit�notarized letter fram owner authorizing same
<br /> dVER THE C UNTER:PSRMiTLiNG . -- �(Front of ApplicaHon Onty)�- t •
<br /> Reroafs if shi gles Sewers Servlce Upgrades A/C Fences(PlobSunrey/Footage) ���.��
<br /> —s- ��•,,;�`=:.:,sxisa-��.s.cX`,,;,..:�r...F;' 'sr.�� t rtou��F.
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<br /> Drivewa NotoverCouttterifonjpublfcraadways::needsROW:;?'��; r'� ,�`:�r,=`r;
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