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i <br /> 81�-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 <br /> ' ' Building Department <br /> DateReceiv,�ed � `b a(��� 3J�a ��9�f _ <br /> Phone Contact for Permitting <br /> +rrrrru-rr - - - - - - - rrrr-r <br /> Owner's Na�l e C. � Owner Phone Number 1` (pJ��� <br /> Owner's Adtlress � � 1.,� Owner Phone Number <br /> I <br /> Fee Simple�7itleholder Name Owner Phone Number <br /> II ~ <br /> Fee Simple II itleholder Address <br /> JOB ADDR I SS � UI Q.I , LOT# � <br /> SUBDIVISI N � i.�PARCELID# �O'��^ � D •V OQO � O�i !D <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED � NEW CONSTR ADD/ALT 0 SIGN Q 0 DEMOLISH <br /> � B INSTALL e REPAIR <br /> PROPOSEIUSE � SFR Q COMM � OTHER <br /> TYPE OF CI NSTRUCTION Q BLOCK Q FRAME 0 STEEL Q <br /> . 1 � W � <br /> DESCRIPTION OF WORK 1 1 1 W � <br /> BUILDING IZE SQ FOOTAGE� HEIGHT <br /> � <br /> I <br /> OBi ILDING $ VALUATION OF TOTAL CONSTRUCTION <br /> QE! ECTRICAL $ AMP SERVICE 0 PROGRESS ENERGY Q W.R.E.C. <br /> � <br /> � <br /> QP UMBING $ � -i r � <br /> �. <br /> ECHANICAL $� � � VALUATION OF MECHANICAL INSTALLATION <br /> Q IAS Q ROOFING Q SPECIALTY 0 OTHER <br /> FINISHED I LOOR ELEVATIONS FLOOD ZONE AREA QYES NO <br /> BUILDER COMPANY <br /> SIGNATUR REGISTERED Y/ N FEE CURRE� Y/N <br /> Addre s License# <br /> ELECTRIC� COMPANY <br /> SIGNATU� REGISTERED Y/ N FEE CURRE� Y/N <br /> Addr i s License# <br /> PLUMBERI COMPANY <br /> SIGNATUI�E REGISTERED Y/ N FEE CURRE� Y/N <br /> Addr I s License# <br /> I c <br /> MECHANI�AL /�� COMPANY �C1�1� �lr ��T� l er���� �I.�� <br /> SIGNATUI�E � REGISTERED Y/ N FEE CURRE� Y/N <br /> i ryn <br /> Addr Ilss , , � {p�I License# l.R� ' � <br /> OTHER I COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Addr�ss License# <br /> Illllilllll / 11111111111111111111111111111111111111111111111111111111 <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction, � <br /> I Minimum ten(10)workinp davs after submittal date. Required onsite,Construction Plans.Stormwater Plans w/Silt Fence installed, <br />