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� 1:5 - l�U - �o2j <br /> r. et�-�eo-oo�o� City of Zephyrhills Permit Application Fax'8�3'�80-002� <br /> • Buildfng Depar6nent <br /> Dato Recelved -��-/ lv Phoee Conteet tor P�rmlkin �13 �(o� _ 4 Y g 2 `_ <br /> Ownds Name 17 O m A S s� Ownsr Phone Numbor �7�` ,3U - �JSy <br /> , Ownors Address S� ( S /��' S���'� � Owner Phorro Number <br /> F��Slmpte 7ltleholde Nam� Owner Phone Number <br /> F��Simple TMtahalde Address <br /> � 5�( S ��� S T��C � LOT� � <br />� JOB ADDRESS <br /> SUBDMSION PAF3CEL IDM I�Ztp��I J �'�J ��'d��'�'��� , <br /> (OBTAINID FROY PROPFR�Y TAX N07It� <br /> WORK'PROPOSED e NEW CONsrR 8 ADD/ALT Q SIGN Q Q DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED U3E Q SFR Q COMM Q OTHER <br /> TYPE OF CONSTRU ON Q BLOCK Q FRAME Q STEEL Q <br /> DESCRIPiION OF W RK � C �'A*-� C�,� C��T O� j' Lj" $-f'c'-:L ►'+'1" I <br /> BUILDINO 31ZE SQ FOOTAOE� HEIQHT � � <br /> OBUILDING S VALUATION OF TOTAL CONSTRUCTION <br /> OELECTRIC S AMP SERVICE Q PROGRESS ENERGY Q W.RE.C. <br /> QPLUMBING S � <br /> �MECHANIC S � VALUATION OF MECHANICAL INSTALLATION �(� <br /> (plS �0 <br /> QC,pg Q ROOFING Q SPECIALTY Q OTHER <br /> FINISHED FLOOR EL AT10NS FLOOD 20NE AREA QYES NO <br /> BUILDER COMPANY <br /> " SIGNATURE REGI9TERED Y/ N ��� Y/N <br /> Addnss Lleense# <br /> ELECTWCIAN �P� <br /> g�GNA7URE REGISTERED Y/ N �cu� Y/N <br /> �d� Lleense# <br /> PLUMBER �P�' <br /> g�p�7U� REGISTERED Y 1 N FEE CUARE7� Y/N <br /> Addross ' Lleense# <br /> MECHANICAL MpANIf b S'e—d��►li ��� <br /> g����pE �� REGISTERED Y/ N �cuaaEn Y/N <br /> Addrose �' 1 O A( (�• v'�Y�-� Llcense# <br /> OTHER. COMPAN1f <br /> g��Np�� REGISTERED Y I N �cututa Y/N <br /> �d� Licenae# <br /> i-1 f 1-11-7 1 f- 1�7-17'f 7 1 fT 1 f-f f 71-1-1'ii 1 1 1"�1 I'77 f 1-1 f17 f1 1 TT fT1'I T 11-17 T7 rTl 1 7'1-1`I <br /> RESID�NiIAL ch(2)Plot Plans;(2)seffi oT Bullding Plans;(1j set of Energy Fortns;R-4W PermR for new constructlon, <br /> Inlmum ten(10)woddng deys efter submilfel date. Requlred ansfte,ConstrucUon Plens,Stormwater Plans w/Sik Fenee Inatelled, <br /> ifery Fadiftles 81 dumpater,Sfte WoAc Permk for subdivisionsflarge proJede <br /> COM{kERC1AL ch(3)complete sets oi Building Pians plua a Life Sefety Page;(1)set of Energy Forms.R-O-W Pertntt for new canstructlon. <br /> Inlmum ten(10)woridng days after submkfal date. ReQulred onsite,ConstrucUon Plans,Stortnwater Plans w/Sllt Fence Installed, <br /> itery FadlMies 81 dumpster.Ske Work Pertnk for all new projeets.All eommerdal requirements must meet complfance <br /> SIGN PERMR ch(2)eets of F_ngineered Plans. , <br /> PROPERIY SURVEY requlred forall NEW consWcdon. <br /> Dlr�ctlOns: <br /> fil�out applica n wmpletsly. <br /> Owner 8 Con Gor eign back oT appllcatlon,notarized <br /> , H over 52500, Notlee oT Commeneement ia�oquirod. (I11C upgredes over i7500) <br /> " qgent(for the tractor)or Power of Attomey(fa 1he owner)would be someone wfth notarized letter from owner authorizing same <br /> OVER THE COU R PERMITTIN6 (Front of Appllcatlon Oniy) <br /> Reropfd H shingles Sewrers Servlce Upgrades AIC Feneea(PlotlSurvey/Footage) <br /> Driveways-N over Courrter ff on publle roadMrays..needs ROW <br />