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From:Ashtin Be�ve Fax:(877)265-18r'1 To.+18137800021 Fax: +1813i800021 Page 3 of 4 10128l2018 12:25 PM <br /> e��-�eo�oozo i Ciiy of Zephyrhiils Permit Application Fax-87�78D-0021 <br /> iBuilding Deparlmenl i <br /> Dala Racalved � <br /> '(`�'t'i-1"I'I-1 ! PhonB Contact For Permittfng� _ <br /> Q— - i <br /> Owner's Nama �GLfNI� Ownar Phone Numbur <br /> Owner'e Addrens S��IO � � ST' OvmerPhona Numbe� ��J" 1 I� <br /> Foo Slmple TIIlehoidor Namo � Owner Phone Num6or � I <br /> ! <br /> Fae Slmple Tlllahnldor Mdross f � <br /> J06ADDRES9 �!� �V��O VT ���� L JJJ-1Z LOTtF G.� <br /> SUBDNISION I H � ti'4-5 PARCEL IAJi !t—zb�ZJ—n'z.(�_oypd—�,�0 <br /> (09TAlHED FROM PRDPERTY YA%NOTICE) <br /> WORKPROPOSEC e N�[ONSTR ADDlAI.T Q $IGN Q Q DEMOUSH <br /> INSTALI � REPAIR <br /> PROPOSED US� Q SFJR Q COMM � OTHER <br /> TYPE OF CONSTRl1CTION Q BLOCK Q FRAME Q STEEL �, <br /> DESCRIPTIOkOFWORK 1"� ! FQ^ ` _�• Y�L.L�p ,1 <br /> t tn <br /> 6UII,DING SQ$ I SQ FOOTAGE � HEIGNT 1(� <br /> QBUILBING a .� VALUA710N OF 70TAL CONSTRl/CTI�N //_�� <br /> �ELECTRICAL S � AMP SERV�CE Q PRpGRESSENERGY Q W,RE.C. �/�"{" <br /> � lV <br /> �PLUMBING S i � � <br /> ' ���j�G��n/1�{� <br /> QMECHAhfICAL g � VALUATION OF MECHANICAt INSTAlLAT30N �l � r�` <br /> QOAS ROOFINo SPECIAtTY o7HER � � �/ n �� <br /> � � � � � � �� � <br /> FINISHEDFLQOR ELEVATlON� ; FLOODZONEAREA []YES NO � '� <br /> � � t�/ � <br /> i <br /> BUIL�ER � COMPANY <br /> SIGNA7URH aEGSStEaEn Y/ N FEEGUaaEn Y/N <br /> Addross � License 7! <br /> i <br /> ELECTRICIAN � COMPANY <br /> SIGNATURE I n6GistEaEn YI N r�ewru�n Y/N <br /> � <br /> aaa�eza i u�a�a <br /> i <br /> PLUMBFA I COMPANY <br /> SIGNATURE � REG�S7EAED Y f N FEE CURREn Y J N <br /> Addross � License B <br /> MECt1ANIGAI. � GOMPANY <br /> SIGNATURE i aeGiSieaEo Y! N FEEcuxRen Y/N <br /> Addross � • Licenso# <br /> OTHER � COAAPMtY � CO <br /> SIl3NATLIR� REOISTEREn Y!N FEECURRE� Yf N <br /> Addresa 2� �i is8 y• License8 � � � <br /> 11f1111111111111111 I�11111 [ 11111111II1111111111111 [ L1111l1111111111 <br /> AESIOENTlAL Atlach 2 Plot Pkns; � <br /> ( ) {2}agts of 8utlding Plaas;{1�set of Energy Forms;R-O-W Permlt far new canstruclbn, <br /> Minimum taf(1�)warking bays afler suhmitlal date. Required onsite,Coru Wction Plans,Stormwatat Plans w/5ift Fonco installad, <br /> Sanitary Facilities 81 dumpater,Site Work Permit forsubdivlsiansRarge pro�acts <br /> COMMERCIAL Ariach(2)complete sels of;8uilding Plans plus a Lifo Safaty Pago;(1)se!of Enorgy Fo�rns,ft-O-W Permit for new conslructlon. <br /> Mlnimum ten{70)working days ettef submidal dnte.Required onslle,CanstnicUan Plar�,Stormwafer pfans w!Silt Fence instaUed, <br /> Sanitary PaGllues d 1 dumpater.Slle W ork Permil tor all now projeets.All�ommerciai mquirements must mect compiianec <br /> SiGN PERMIT Attach(2)sets ot Englnesrgd Plans, <br /> ••••PROPERIY SURVEY raquirad for all NEW construpion. <br /> � .�. <br /> Directions:' , • • • • • • • • � i <br /> FlII out appllcatlon campletety. <br /> Owncr 8 Conlractor slgn baak of appGcatiDn,notarized <br /> If over SR500,a Nopco ot Commenceminl Is reqvlred. (A/C upgradae over f7500j <br /> " Agant(!or the coniractor)or Power nf Atln�mey(for the owner)would be someona wilh noterized letler from awner eulhorizl�g seme <br /> OVERTHECOUNTERPEitMtTT]NG (copyo(wnVactrequirod) <br /> Reroptslfshingtos Sewers Serviee�Upprados A/C FeneesjPlat/5urvaylFootaga) <br /> Drlvaways-Nol ovar Counter if on public i dways..needs ROW <br /> � <br /> i <br /> I <br /> i <br /> t <br />