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• 8`�3-780-0020 j Fax-$13-784-442i <br /> , . C�ty of Zephyrh�lls Permit AppiEcat on <br /> - • Building Department <br /> Date Rece� ed >Q / <br /> / /�� �Gs Phone Contact tor Permitting - <br /> 1 f ! 1 li! ! 1 1 1 1 i 1 <br /> Owner's Name P'1 Cb `�d c'i - �:,. Qwner Phone Number +�/ �• ��� <br /> Owner"s Address tp�� �`��'t�C�Oi�r ��" �+��Y � Owner Phone Number �— � <br /> Fee Slmp!I Titieho[der Name ���" � � Owner Phone Number � � <br /> FeeSimpl; 3ltiehoiderAddress <br /> i /� / r <br /> JQB ADD ESS ���i �����5L'.�"'�C�'� /��`l ��L.'r/ LflT# L=f-� <br /> SUBDIVIS�ON r/ � ��Ld'C-�++�' PARCEL!D# �� �� �� �� ��l«'� �'"��� <br /> � <br /> �� {OSTAIFiED FR4M PROPERTY TAX NOTIC� <br /> WORK PROPOSED NEW CONSTR ADD/ALT � SIGN Q Q DEMOLISH <br /> I � 1►dSTALL 8 REPAIR <br /> PROPOSEp USE �'"` SFR Q COMM 0 OTHER <br /> TYPE OF GOt+ISTRUCTiON Q BLOGK Q FRAME � STEEL Q <br /> DESCRIP I�ION OF WORK ��� ���� I ��� � � ��" ���� ' C�- �''��X -'����� <br /> Q ��G� <br /> BUILDINGi SIZE � � SQ FOOTAGE ���� HEICaHT `�� ��,/ � <br /> �6UILDING $ �,�f d�� VALUATIdNOFTOTALCONSTRUCTION <br /> :�� <br /> QELECTRICAL $ ����, ,zc� AMPSE�� Q �� �� �""� W.R.E.C. <br /> Y � <br /> QPLUMBiNG $ ���� ,�•� �,(� � �� /'� <br /> I ""�I <br /> Qi EGHANICAL $ ������Q� VALUATION OF MECHANICAL INSTALLATION <br /> QGAS Q RdOFING Q SPEGIALTY 0 OTHER �r� <br /> FINISHED IFLOOR ELEVATIONS C�� LOQD AREA �YES O � ��,k'`7� <br /> • • • � • • • 1 Y • • •. � • .• • • • � � • � • • • � • • � Y • • Y. � • • � • • Y. • • � .■..... ...■..__ <br /> HU�LDER�� � _ ,/.--� �,_ COMPANY � � F�►� �'`{''b ^ ���- <br /> SIGNATURE � E�����a� `"�� REGISTERED Y/ N FEE CURRE� Y/N <br /> Addr�ss ����-�- � '� i'� �'� e'"^ /"' �G.�'W License# �i,bjC���!".�� ..C� <br /> � — <br /> ELECTRiGtIAN COMPANY <br /> SIGNATUFIE �r�"� REGISTERED Y/ N FEE CURRE� Y/N <br /> Addr'�ss License# � � <br /> i! <br /> PLUMBER CdMPANY <br /> SIGNATURE FiEGISTERELI Y/ N FEE CURRE� Y/N <br /> Addr�ss License# � � <br /> MEGHANICA� '� COMPANY <br /> SIGNATURE � �"^"" REGISTERED Y/ N FEE CURRE� Y/N <br /> Addc,ess License# �— � <br /> OTHER ; COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE GURRE� Y/N <br /> Address �icense# �— � <br /> IIII � IIIIIIIIIIIIIIIIIIIIIIItllllllllllllllllllllllllllllllllllllll <br /> RESlDEN� IAL Attach{2)PEot Plans;(2)sets of Buiiding Pians;{t)set of Energy Forms;R-O-W Permit tor new canstruction, <br /> � Minimum ten{1 d}warking days after submittai date. Required onsite,Cons#ruction Plans,Stormwater Pians w/Silt Fence instalted, <br /> Sanitary Facilities&1 dumpster;Site Work Permit for subdivisians/large projects <br /> CQMMERIGIAL Attach{2)complete sets of Building Plans plus a Liie Safety Page;(1)set af Energy Forms.R-O-W Permit far new construction. <br /> Minimum ten(1 d)working days after submittal date. Required onsite,Construction Pians,Stormwater Ptans wJ Sitt Fence instaitad, <br /> / � Sanitary Facilities&1 dumpster Site Work Permit for all new projects.All commercial requirements must meet compliance - <br /> 81GN PE MIT Attach(2}sats of Engineered 3'lans. <br /> i ****PROPERTY SURVEY required for al(NEW construction. <br /> Direc#fon�: ' <br /> Fill oi�t app(ication completely. <br /> Owner&Cantractor sign back of application,notarized <br /> ]f av'�r$2500,a Not[ce of Cammencement is requlred. {R/C upgrades aver$7540) <br /> ** Agerjt(for the contractor)or Power of Attomey(for tha owner)would be someone with notarized letter from owner authorizing same <br /> I <br /> OVER THE GOUNTER PERMITflNG {copy of cantract required} <br /> fleroofs if shingles Sewers Service Upgrades A/C Fences(PIoUBurvey/Footage) <br /> Drlveways-Not over Caunter if on public roadways..needs ROW <br /> i <br /> I <br />