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I <br /> �il10/17/2016 13:29 7274474888 SOUTHPORT CONSTRUCTI PAGE 01/03 <br /> i <br /> �i s��.�ao.o�o City Of zephyrhills PermiE Application Fa=-s+a.�eo-0o2+ <br /> BundMg Depanmant t <br /> I'� , ,,,_ �st�tZl�.vtn�,�Q.3 K �S CO s'ac�`ton,.Cc <br /> ae���"'aa �� ~ P�ona Conract tor Permt 727 44 - 'I 813 <br />' .. I �r-•� r�-r�r•r•r cr_r_ �-r <br /> II Owner'sName Jan Kin �rlly OwnorPhoneNumOer <br /> . i owners adnrass 35 Sockanosset(;ro.�;;Rd RI 02920-5535 (wy�p�phorro Numbar <br /> ll Poe Simplg'TitWholder Nama Jan KiP+g U�,r., OWner phon8 Number �� <br /> � <br /> �j�, FeaSlmpteTltiaholdarAddre� PO 3o%c 8999 Cranston RI d2820 <br /> .�j �o�AODREss 5690 Gall �il��d,zephyrhills, FL 33542 �ora �� <br /> StlBory�StON _�,_,_� ppRCEl.Ip� �1-2�-21-0010-05700-0255 <br /> fOBTAl1�D FRIX�9 PROI'ERtY TA)I M0710E) <br /> WORKPROPOSED e NEWC�.NSTR� ADD/ALT � S�GN � Q DEMOUSH <br /> INS7Al.l, REPAIR <br /> PROPOSED USE Q SI�R 0 COMM �] 0T1iER <br /> TYPE OF GONSTRUC110N [] ei.nric � FRAME Q 9TEEL Q <br /> GESCRIp'�pN OF WQRK Renow��ii:ions to an existing Bur�er King#4079 <br /> BWLOING SIZE ] Ei�i FQOTAGE� HpGHT � <br /> �� <br /> �BUfLDING � •� �� VALUATIONdFTOTALCONSTRUCTION <br /> � v �--� <br /> QELECTRICAI. S AMP SERVICE [� PROGRESS ENERGY Q W.FZE.C, <br /> [�PLUMBING S �^.^ <br /> ��._� �, ���L-, r,, <br /> OMECHANICAL S VALUATION OF MECHANICAL INSTALLATION _l_ -' J ���(/ <br /> �_�_� l � i <br /> QGAS Q RUp^qJG � SP�C1AL7Y� OTHER 1 <br /> FINISIiED FI.00R ELEVA7101d8 F6000 ZONE AREA \ QYES NO <br /> C�.-- �'�;�, �-�/ <br /> �� � <br /> �p �r _ �I,,}�p'r <br /> BUiL�ER ' '�] �'� � � 1�4��PAHY ���W'✓`-�I <br /> SIC+MATURE � I REGt�REO Y/N fEECURREh Y/N <br /> AdAresy 178Z Calumet St�:l c:learv�rater,FL 33 5 u�0� CGC-151Z872 <br /> ELECTRICUW �l_--�����:�"'C!`� , �• ,dO�APANY I \1�f J� C�GC� � <br /> SIGiNATUR� REWSTER� Y! N �Ctsia�. Y/N '� <br /> � Address +-- '� UcBrtse 0 <br /> I' PI.l7MBER f COMPMIY ��{i'��d'a' f JOl'� V�'��l(J�' i <br /> SI4NATURE r� tt�c,�stEReo ! N �REr Y!N i <br /> �� "_ '� il <br /> !' Add►ass Ucensa A��� <br /> I MECNANICAL �oo�xPaHr ��i�2�-� /;�t Co�a'f�•�F•� fL� <br /> SIGHA717RE ._� aEG�STER� Y/N FEBCiJRRE� Y/N <br /> Address �^ LIpEnS81F � O I <br /> ._� <br /> n �� � fl�err� co�epaNr �/'��' -e1�f�AL <br /> /�j �,t,!I t��rplAx�x� �_ aEcrsrea� Y r�u � cuRaen Y I N <br /> r --•�. �� <br /> II Addrase „r,._ Ucer�se# ' <br /> 1111111t11tt11tli11t1911�111111t � 111111111111fIt11t1Allfllt11f111 � 11 <br /> II RESIDENT1Al Att9Cn(2)Ptpt Plans;(2)s[�s o'6uiW{ng Ptans:(1)sel oT Energy Forms;R•O-W PertnN for rxw conshuClon, , <br /> Minmum ten(1�working Haya nllcX submittal date, R�ulred onslte,Cor�IrucOon Plans.9to�mumler Plans w/StR Fence Instai�d, <br /> Santtary FactliNes&1 Cump6t+x;:3P�e Wo�k PermR fo�dupdf�n@bne�la�+ga Pro�cts <br /> CCEAMERCtN. Ariach(2)cvrnptete�ets o4 Bv:lding�Plans gius a lJte Setaty P�qe;(1)set of Erxrgy Forms,R-O-W PermH for�evvconstrucflon. <br /> Mfnimum ten(10�working�laya all�.r submittal date, Requlred onslle,Co�tnictlon Pians.St6rtmval¢r Ptans w/S#B Ferx�e Instalted. <br /> SaNtary Paellltles&1 duMpsir:.r.;iPte wonc pemilt fa�att new pro�ects.All commerGel re�iremente must meel complferroe ' <br /> SIGN PERMIT AtlaCh(�88ts of E�gInCEa:q P!FIIt9. <br /> '�"PROPERTY SURVEY requL��ri tor all NEW corishuellon. <br /> .�.a. I <br /> oirecuons: <br /> Ftl�out apphcadon eampletety, i <br /> ONmer�CotlVaCtor eign back of appticatlqn,rnde�izetl , <br /> II, tt ovar S2M0,a Motica o!Commenc6tilnrd h iequlred (NC upgra0e9 over S7Sa� <br /> " A9�rM(for ti�wntrscto�a�Powe�ot Attorr+4 y•,i��the avne�wauld bc someone wfth notatixed teHer from wmer avUwd�ng ea�e <br /> I' OV�R 1HE COUNTER PERMti71N0 (a,py at ix�Mraet neqWre� <br /> ReroMs fishinples 3ewers 5e��Upgrarlu�s NC Fences(PIoU3urveylFootage) <br /> Orivaways-Not ovar Courtter R on pudlC�O�v�ni.•exatls ROW � <br />