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813-780-0020 City of Zephyrhiils Permit Application Fax 813-780-0021
<br /> ' � � . Bullding Departrnent
<br /> Date Recetved J� -r3—l,� _: Phone�Contact for:PermltUn - � ,o r3 - �� - ��7 I �
<br /> ` Owner'a Name ��`^'`� �r"S� Own�r Phone Nlumber
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<br /> Owner'sAddrass +°:91 � N ���• S � �'�""�'�-��� �' p�ynerPh'oneNumber�•
<br /> Fee Simple 71�IefiolderName - —� � Owner Phane Number ' �
<br /> Fee Simple 7ltleholder Addresa -
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<br /> JOB ADDRESS � ] I S � S +' LOT# �
<br /> SUBDIVISIOPI� , �free � PARCEL ID# � - �
<br /> I . (OBTAIWED F.ROM PROPERTY,TAX NOTICE�
<br /> WORK PROPOSED ,��NEw CON57R , ADD/ALT �� SIGN' "Q Q �DEMOLISH
<br /> ; _ INSTALL � ,. �.REPAIR
<br /> PFtOPOSED:USE , -• :Q SFR. � COMM . ` Q- OTHER '
<br /> TYPE OF CONSTRUCTION•'"�� Q� '�BLOCK � � FRAME ;Q STEEL 'Q
<br /> �.. ,�
<br /> DESCRIPTION�OF WORK, �
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<br /> BUILDING'SIZE' � � �'�Q�FOOTAGE� HEI,GHT``�
<br /> QBUILDING $ VALUATION OF'�TOTAL CONSTRUCI'ION � '
<br /> �E1.E�CTRICAC $ �i � � AMP SERVICE, � �Q '�PROGRE$S ENERGY Q W:R:E:C.
<br /> OPLUMBING • $ .. - -• ' ,
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<br /> QMECHANIGAL � $ ' ' VdI:UATION O�MECHANICAL IN$TALL'A7'ION:
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<br /> QGAS f . �] ROOFING Q, ;, SFECIALTY�.,Q.�.•..OTHER,- : , . , �
<br /> FINISHED FLOOR ELEVATIOfVS FLOOD ZONE AREA ,QY�S. ,NO
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<br /> BUILDER � , , . COMPANY`, . ,�'', . .-;�. , , , , , �
<br /> SIGNATUPtE I REGISTERED Y/ N Fr��F.EE CURRE�=' � Y'/'N` ,
<br /> . at, ,at.` -`t:� ,`�_s.s •`w_ ;'� '� _ .
<br /> Address ,�_ ,. y ,.+: ., <Gicense�#:' c ,
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<br /> �.#COMPANY�`� r , . . �.,.s '"; : r
<br /> SIGNATURE � i � ���s�rteo Y/ N �E�cu��,� �f��:Y/:N.= . -
<br /> Ada�.� i ���g`3..�.� :;�-����a C1�"�D!' .`5, , , ,� ,�:.Llcense�#�;-���3�a�5�,9�=r
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<br /> PLUMBEit ' � .., _�C.OiNPANY �::�z..4:a..,. ,r ,: �:,_;.,�. .: �;� :. �.
<br /> SIGNATURE^' `� � ' � " FtEGIS.T,ERED Y,I.=N:; . r;��cuitrte�,•?,' -^.Y:�/N, _ , �
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<br /> Address � ' ' -�_` ' . � " '� ;License�#' ` _ _ .��-, _ �
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<br /> MECHAI�IICAI:`..I�, . • - . , ' , t. , . - . • COMPANY � .. ,., �.;r:,:A�„ „ _ � V. .1
<br /> SIGNATURE� y'x� � REGISTERED Y/.N �E Cu�itEn:ti, Y/-N+
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<br /> Address'` i'1 , ._ . ,. ; . .-��� . �.� t. _ � ' " �.License#`. _'�_ . ,
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<br /> OTHER r�: . .. _ : . ,CO,MPANY � .:. _.�--- . .
<br /> SIGNATURE� - - . :$ .. .,'•" ==i .'� '_ , , _t. _ �:...:..,. , ,� .. ,v , , Y'/N .
<br /> '',r' 'REGISTERED�"'"� Y/ PF:.... ;FEE CURRE�•
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<br /> Addee� .�,,..,.,� r.H' ....c..•� .- � - � - ��, .., , . ' �r Llcense#���� �
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<br /> RESIDEN7114L 4Attactir(2;Ploti,Pla"ns;�.(2)sets4of'Buildf'ng'[Plans;�(.1)set of�Energy-Fo'rms;�R=0-1N•`Permlt fo�newrrconstruction,.
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<br /> - ,���Mlnimum�.ten„(1,0)�,worl�Ing;d�y,s,�aRerbsubmltital:dafe t;.�Requlreil onslfe;'Cons#ructlon'Plans;'Sfoimwater Flans wl Silt Fence Installed,
<br /> ``�'_.; Sen(tanr F-adl!y�s�1��wmRster�Ile•bVorktPertnl�•far:suti�idislonsllarg�_�projec�V��'�;���,. '�'-'';���% �' ''� ''` ,
<br /> CO[YIWIERCIAL , Attach(3)�eomplete'sets°of''Bulldl`ng'Plans"p'lus a Ufe�S'afety�Page;(1)set of Energy Forms.R-O-1iV Permit for new consVuctlon:-
<br /> Minlmum ten(10)worktng days after submlttal date. Requtred onslte,ConsWcdon Plans,Stortnwater Plans w/Sllt Fence Installed,
<br /> , $anitary Fadlltlas&1 dumpster.Slte Work Pertnit for all new:proJecfs::All commerctalregultements_must meet compllance �'�
<br /> SIGN PERNOIT AttacFi'(2)'sets of Enginee"redsPlans:,;�:�;��V��; .. ,�.. ..w:-:> ;. „ �-� .
<br /> NHPROPERTY SURVEY re_quired for all_NEW co.Dstructlon....... .. ... - - .
<br /> Dlrectlons: •�=e�a�.s;',,": . _ ,
<br /> FIII out eppli I Uon completely. �
<br /> Owner 8 Conhactor slgn back of appltcatlon,notarized
<br /> If over�,2500,,a Notice of:Commencement Is rsqulr�d. (AIC upgrades over ST500) ; •.
<br /> .�`;:,,y,;ay.~�s;.";�a
<br /> " Agent(for th�contractbr)or'Power of Attor"riey'(for the owner)would be someone with notarized letter from owner authorizing same .,
<br /> DVER-THE:COUHTER.PEFYMITTING��---:•-(Front•of-Appllcatlon>Only) •�-- " �
<br /> - Reroofs If shingles Sewers Service Upgrades A/C Fences(PlodSurvey/Footage) _. _ _,.;
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<br /> Orlveweys-Not over Counter If on publlc roaduvays:.ne�ds.�tQ_1f1(�����,����•,€
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