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813•I ao-oo2o City of Zephyrhills Permit Application Fax 813-780-0021
<br /> � • _ �uilding Departrnent
<br /> Date Receive (, ,'��`]� ' (Q 5 ' — a � l
<br /> �' (�'.� �., :.Phone'=Conf�ct.for,�P�rmittin -
<br /> Owner's Nam �Ll��5 S(il �t���l,l O IOv S Owner Phone Numberi V 1�J t,��5.°�.V I
<br /> Owner's Add ss �5`�� �1( SS S Owoer Ph'one:Number.
<br /> Fee Simple T tleFiolder:Name � - Owner Phone Number �
<br /> Fee Simple T tleholder Address A
<br /> JOBADDRE 3 , Y1�_ QS �CJ�V-� LOT# �
<br /> SUBDIVI310 ' PARCEL.ID# � � -
<br /> - , , • ' (OBTAINED F.ROM:PROPERTII,TA7C NOTICE)
<br /> WORK PROP SED �,NEW CONSTR , ADD/ALT �� SIGN' "Q � Q �DEMOI:ISH
<br /> :,e� INSTALL _ �- ,�.,.REPAIR -
<br /> PROPOSED� $E � , , � Q SFR [�- °COMM . ' Q �OTHER � �
<br /> TYPE OF CO STRUCTION`< Q" ;�'BLOCK r [� FRAME '� ,:� 'STEEL' 'Q
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<br /> DESCRIPTIO, OFWORK' ` ��� �J Q, . �$� � � (� i� �.Q� -t
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<br /> BUILDING'SI E�,' �-�' �'�Q�FOOTAGE�; HEI,GHT .. ._ .
<br /> �BUI DING $ � � O� , VALUATION�i'OF�TOTAL'CONSl'RUCTION -
<br /> QEL CTRICAL $ � " AMP SERVICE. ' �•Q `�'�PROGRESS ENERGY Q W.R:E.C:
<br /> QPL MBING� :$- - - . , �� .
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<br /> QME Hi4NICAL' - . $ ' � � VALOATION OF;MECHANLCAL IN$TALLA7'ION:. �
<br /> QGA �] ROOFING ,Q,-,-SPECIAL'1Y„�Q;=� OTHER; ,� , M .
<br /> FINISHED FL OR ELEVATIONS FLOOD ZONE AREA ,[�]Y�S. NO
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<br /> BUILDER ' COMPANY�. :.�: ._:_:.;��;, ,�i.:. - ,:..: . . ,,. � -
<br /> SIGNATURE v^ REGISTERED Y/ N .'�°"��FEE CURREF�-�� '�Y�/'N`- - �
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<br /> Addr�ss i-:�i'.i.. .4 a , . C' 9:� �z - iLicenses#' .��`° -,
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<br /> ELECTRIC � . , , ,,. • szCOMPANY�. �� rn' i=�<.::�r,�;..t;. - ;a. .. - � , . �
<br /> SIGNATURE' �1 REGISTERED 4f 1� Y/ N ,F.EE,CIJRRE�'={ � �'�:Y/:r -
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<br /> Address - . .. . �. � . . -, .. � ;.� � ,�.. . , -_- , :�, . �rt,��'.�:License:#�t�' _ . __. _,- , f.
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<br /> PLUP�IBER ' _ . ',�� .G.OMPi4NY. • �: •.}f t.�;:
<br /> SIGNATURER`� ' ' ` ' ,',REGI§TERED. , „Y.•>jl,,N;, �.F��cutt�n,tj `:Y,.•/N, -
<br /> Addre�s � , « : _. ... - .. ' y:�, t==� ,�--� . ,.
<br /> `Licerise# �:�
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<br /> MECH/WIC � ; , , , . .� . - COM,PANY �:' :. .-: �..�,,.,�,�,. :. �
<br /> SIGNATURE� - :r-,. .... • , - ,. . _x , - � . - , , � -
<br /> FtEGISTEftED _ Y/.,N.� ��5,FEE CURREt�.. Y.LFN:.;. _
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<br /> Addres�� ,. � ._ ,.,., - , -;>:. , .: : , ... - _ : - , , .. License#s . , � _ . . . . ` ,
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<br /> OTHER r.� - .,. _ • _ , . ,:. � ,. ,�..> � ''COMPANY''� � ' � + � �
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<br /> SIGNF►TURE> - ��' _ .'s , - •;` -; :r�� . . . �REGISTERED�' ' Y/`N. " ;FEE�GURRE��_ Y7 N.
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<br /> �RESIDENTI, ';-�'.;�Atfacti"2 dPlotlPlan's;;'2:sefs�of Buildfn �Plaris;�':1 set-'of�Ene ,Forms;�R-O=W-Perinitfor new�constniction�,
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<br /> -�- �,;;,z{Vlinimum�,tens,(;1.0)�wo�ing�d�ys;a[tera'submiftal`tlat"e:�tuRequirsd onsife;YConsfii,icHon:Rlans;Stomiwater P-lans wl Silf Fence�ynstalled, "
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<br /> "�Sanitary Faciliyes;&F7��wm,pster�=Slte�Work Perrnit,#or sutidivisions/large�roje"cts;�,w.=ti;;{;;�s;_w°� - . _ � - �� -
<br /> �OWI6VIERCI Attech 3 eom`lete sets'of'Bu11dIn"Plans'�lus a L1fe S�afe��`Pa e;1 set of Ene Forms.R-0-V11 Permit for neW'constructlon.• � �
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<br /> Minimum ten(10)working days after submlttal date. Requfred onsite,ConstrucUon Plans,Stormwater Plans w/Silt Fence installed,
<br /> Santtary FaciBtles 8 1 dumpster.Site Work Permit for all newiprojects:::All coenmercial.requlrements_must meet compllance '" " �
<br /> _=SIGN P�RMIT Attech"(2)sets of'Eng,i"n;eeied;Pla�is:,:,�"��;x��;..:- .. <=;.,_ .. .. ., - , , -
<br /> •'•"PROPERTY SURVEY requirec�inr,all NEW.constr�cUon.._, - � - •
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<br /> 6lrectlons: . .r:��.,,;+ , ... ,._ .. _ , ..
<br /> FIII out ap Iicatlon completely.
<br /> Owner 8 ntracMr sign back.of appltcaUon,notaAzed
<br /> If over�2 O,,a,Notice;;of.Cor�mencement la required. (NC upgrades over 57500) .._
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<br /> " Agent(fo themcantr2ctor)or_Power of Attoiney(fo�the ownerjiniould be someone+with notarized letter from owner authorizing same
<br /> OVER THE:C UNTERsPEttAA1TTING�•-•-��;•-(Fro►►t-of ApplicatiomOnly)� --- "
<br /> Reroofs If shin les Sewers Service Upgrades A/C Fences(Plot/Survey/Footage) _ t_
<br /> Driweway�-Not over Counter if on public roadway§::rieed�ROW` ' ' � � •.r-.�a�.s.,,d,�,.,a:„,,,'� � � ; �. �_� �^'�� :;;�;
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