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a�a-7eo-oo�o City of Zephyrhills Permit Application Fax 813-780-OQ21
<br /> . Butlding Depa�tment
<br /> Date Recelve .. P.hone;Cantact�for Fermlttin `
<br /> -S'c 3 . 252, _ ,�Dl' .:
<br /> Owner's Namle � L�-! C Owner Phone Numbsr ��o?" '�p -^.1�cxC .
<br /> Owner's Add�ess ./�a ; � le� ,f j Owaer Phone Number �
<br /> Fee Simple 7 tlelioldar Name � � Owner Phane Number �
<br /> 3 .
<br /> Fee Simple T tleholder Addresa "
<br /> JOB ADDRE S /� UV"�i Q �/ �4 �"���"`' LOT# �_�
<br /> SUBDIViS10 � �� • � ' PARCEL ID# � � o�� �fci�d ��� .' � �
<br /> . (OBTAINED FROM PROPERTY TAX NOTICE)
<br /> WORK P120PA8ED �.NEW CON5TR ADD/A!T C� S1GN �Q [� DEMOUSii
<br /> I �-e. INSTALL ,,•,REPAIR �
<br /> PROPOSED= SE � Q $FR Q COMM [� OTFiEFt
<br /> TYPE QF CQ STRUCYION' Q� "'" BLOCK " Q FRAME � STEEL Q
<br /> DESCRtPTIQ OF WORK �Sa ��, /V" e�Q � % ' � �/� C d77'J l3NL'?KI�
<br /> BUILDING'SE E � � �" SQ FOOTAGE � , . . _HfIGHT �E����
<br /> -�•, :�. .
<br /> QBL!1.DING $ ' .� � -
<br /> .,.,._._.„._
<br /> � VALUATiON:t'3F TCiTAL CONS7RUCTION
<br /> ' ,,,, ,,, �l
<br /> QE�ECTRIGAL � � AMP BERVICE Q PROGFtESS ENERGY Q W.it.E.C.
<br /> QPL)M81NG $ , — _
<br /> �
<br /> QMECHANtCRL $ ' VAIUATiqN OF MECNANiCAi INSTALLATION
<br /> �e 3��, b .. , ,
<br /> QC-,AS Q RQOPlNG Q SPECIA�TY C� OTHER �
<br /> FINISHED FLC.10R ELEVATIQNS �� FL.00D ZONE AREA [�YE�a NO
<br /> BUtIDER CONIPANY'
<br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N'-
<br /> Addres - Lic�nse# � �
<br /> EtECTRtCI, : `.COMPANY ' _,
<br /> SIGNATURE '� REGISTEREb Y/ N FEE'CURREP° �Y/N
<br /> Addre� - , . .. �_ License# � - � �
<br /> P�UMBER ', COMPANY � _ , ..
<br /> SIGNATURE ; _REG�9TERED Y./-N FEE CURREA-• " Y/N.
<br /> Addr9 LtQBTtSe,# �— • _ ' �.� I•
<br /> MECI�IANIGAl: �� y���.��X:�� . COMPANY. F�!`�'�/Q-�� j�l�f�R111J�-��S��C°� -�rV�
<br /> 11AN
<br /> SIGNA7URE REGNSTERED Y/ N . �FEE CURRE� Y/�N _
<br /> `� - Y ^
<br /> Address ' �•'�I f "7�1 /- - .c�. fIl�.65 License# �f�� �c'��'� �
<br /> o���� -- , � � � t = , , �� ,.. �:co�t�au�r�� � � � ' � �
<br /> SIGNATURE =- � `� � • � � • � ` �' REGISTERED Y/ N...: FEE CURREI�• Y/N
<br /> Add[8 ' � ,,; : ' � " �.3 y , : _ UC8T1Se# �' � .
<br /> �.. _ ,;�;: .. . .., �- . . ; _ ; :
<br /> ,.v., _ .._. .., .�. �nn,,.... , � .
<br /> RESlDENTIAl;,, �A#tActi'{2}rPlo#�P,lans;:�(2}se#s-6f�Butliflitg'Ptans;'(1}se#of°Enecgy=Farsns;R-0=W`Pemiltfor new construction,
<br /> ______�.__—_�_�::�. Mintmum�.tem�(,1,0);,warking��days;afte_r,:submiftal dek'e::_Requiretl onslte;:Gonstiucdon�Plans;Stormweter"Plans�w%SIIt Fence�installed,
<br /> • --� _..
<br /> ----- -_ �-;__ .--__ --. . _--.---- _— ,-._. �
<br /> "' Sanitary�Fadlltles 8�1�dumpster,-,31te Work;Permit#or.su6divisions%large'projects-. . 4:
<br /> G4MMERC11�t. Attach(3)co�nplete sefs"of Biiilcling`Ptaiis ptus a�l.tfe Safe#y Page;{4}set of Energy Forms.R-Q W Perm[t far new construi;tlon.- =
<br /> � Mlnimum ten(10)worktng days after subm(ttal date.. Required ansite,Constructian Plans,Stormwater Plans w/Silt Fence installed,
<br /> Sanitary Facfl[des&1 dumpster.Slte Wark Permit for all naw.proJecfs.All commercial requlrements.must meet compliance � �
<br /> _.._ _. ..
<br /> SIGN PERMI i Attat�i{2)"sets of Engiiieered;Plans.; ._�°,,.�- ,. :_ � ,.� . '
<br /> ""PROPERTY SURVEY reguired.for.all,�NEW canstrucUon.,
<br /> Dlrec#!o»s: � .. ...�- t- _ _ . ,
<br /> Ftll out a plicaUan completely. -
<br /> Owner&Contractor sign back af appticatlon,notarized
<br /> tf over 3 500.a Notice of Commencement la required, {r4/C upgrades aver 57500)
<br /> " Agent(fqr the contractor)or Powe�`of Attomey(far the owner)would be someone wlth natarized letter from owner authorizing same
<br /> �.
<br /> dVER TFiE C�tYUNTER>AERM17T1 '""��(�fir6r'"�r��t, ,�ori'�Oritl')"'�a-0�.� �.3�»�::���::.�iM�z�x.,���
<br /> Reroofa If shle�gles Sewrers .„,tSer'v�c�1���'g'racTes�1A/C Fence's'�I?IodSurvey/Footage) �w,�y;=K:r �.a;t+f�t"�
<br /> _. .__ .. .-._ . Ee:'�^ !?.:e.,: ; �sl;!q!l�: .'F'�f:t � '� • .(. �;� _ � .'�;l�a!i::,,__3c. . ,tlR7,�r v+, ` - � .,
<br /> Drivswa -tVat aver Courter an�pubii��c`aiiwayls:.need's l20NV i� '�f" `i�'i� � .;t; F' '���•;�•�;x' , , > ` -
<br /> P,� �,'' ti:�4t� �" �i irii ;t:;� ?.�� _ 4t�,��� � � ifF;^ .� : r5 ; ,. , . � D�
<br /> �:Y1jG'.: I!'"��t'.:S'� ,.,.,'i�l:;.11):' .Y^��''�.�,a *'�`� t� .:.��� =' � '+';71 tl :4 ..� '�
<br /> �p-� ,� ': � �>.:i: +,?. �;�r `'+ tx
<br /> iY'�`Y+` -�d� ✓-3��j-'_.'t'4��-'-.."`�G"n�4��..." ��A��.:rt.N�f:V.{T�:.,SstYq�,YS=:!'����,:�.�'p�yt�i���'W`"'�4"�53
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