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<br /> 813-7� aoo�o City af Zephyrhilis Permit Applica#ion Fax 813-�so-ao2�
<br /> f' � BuNding Departmen4 -
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<br /> Qat�Reaetvedi �, � ;.:: Phane�Gctitact':for.�Parmtttia _ _ , , ,
<br /> (,tl��� e '�� Y !C� P Gt�� S Own�ar Phone Numher
<br /> Owner'�Nam� "� �7 .
<br /> Owner's Add as 7 Z� C ..v'� . Owner Ph'one:Wumber.� � � �
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<br /> Fee Slmple.Tit etiolder•Name � r � � ' Owner Phane Number � �
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<br /> Fee Simple TI eholder,Addresa
<br /> JO@�DDRES ..��7 'I� ! � �� t LOT# ��
<br /> SUBDIVISIOPI ,� • �� R!ARCEL i0# ' •
<br /> , , (OBTAINED F.ROM:PROPERTY,TMX NOTICE)
<br /> WORK PROA�SED x�NEW CONS7R ADDlALT �� SIG�V` `[� � `Q �DEMOI,ISH
<br /> . . >.�, INSTAI.L � .�.-REPAIR .
<br /> PRQPOSED� ISE , � :Q 3FR [� 'Cf)MNl� �: `- � �{}T#iEEt :
<br /> TYPE OF CO 3TRUCTIOPI""�' ��„ �''BLOCK " `[]` ' -�RAnAE " 'Q "STEEL `Q
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<br /> DESCRIPTIO OF WORK` • ' � 't-�� `r�G 1„"vl�l� �t�l '
<br /> BUILDIAIG:SP E�= .��� �'��00'PAGE��1 !O�n , , ,HEI.GHT��. ����____�
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<br /> QB�� �1�C' $ �7 �G) VALUATION"'t�F`TOfiAI-00�181'Rl1GTION A , .
<br /> QEL C'(itICP1C $ ' AMP SERVtCE ` °Q "�PFtOGREfiaS ENEFiGY Q W:R:�:C.
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<br /> OPL NlBING� �
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<br /> [�ME HANIGAL . $-, .,. �_ VAll:JATtON O�IVIECHAidIGl,4L Fht$'fi4CLATItQN.
<br /> [�GA+ [� ROOFIP#G .C,�.�„ SPECIPd.`!'Y.;:[�...,:OTNER, �,: v
<br /> FINISMED Fl.) OR EI.EVATIONS FLOOD ZONE AFtEA 2 QY�S. NO
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<br /> SIGNATURE REGISTEREp Y/ N :' �'�:°�FEE cu�n-1� ' °;Y%'N�- �- :
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<br /> Addrass �..�4' �fp /t,� r,,,y _ � .,��:i - .:License=#:, .�;,_,,.- ,,`.;.. . .. . �
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<br /> EL�C1'RtC , _ . - r.;GGMPA#�1Y�;��} - „-�, t�� =,:z;�-<�.3�: _ .:_ '. • __ ,
<br /> SIGNATURE � �REGI3TERED Y/,N FEE'GU.FtRE�k"f ': _>:Y/N'-'
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<br /> P�UMBER., . . - , . ,GQMPANY ., ' }`f'1 �_ .iv `
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<br /> SIGPlATURE�: - ' • . . , ' ;y`'REOIS,T.ERED , :Y/,N:.s FEE:CURREP::= ,wi, ?Y�Y.N� _ .
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<br /> SIGNA?UttE�I �='. , � - , � REGI$TERED Y.,%,N,- ��r:FEECUtt�n:.,i 'Y/�N:..,; .
<br /> ,� ,S, i - ..: .�-_ - ��'3.' _ ' . .. � . :'.'3 F,Y�x�. :1 .1�-�
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<br /> SIGNATURE�I'<:_..:,; ,.:.-';+. :.;'°:,:: . ,-'r�? <'- . . ° .. . ":,• � �REGISTE�iiE�'�:x , Y!�N:..:.: ;F.EE.�URRE�• Y/N
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<br /> "`".,13;°+`'1 :i%r�i ''*.�'t;•a�,` �,s:k .:7- �`-w•: ,•.I:,. �'�'"�115$#:.
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<br /> ttEStOEN'fl,.�w-nT�:�Aitai�:.2�„aPto_`f_Pla�ts;;.2 sefs�o`�'Bti�tc�ln`t:�lans;�(:��set�of;Energy�Forins,�R�W�Pertn�t#ii'r'=nevu coosfNc�bn, �
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<br /> � M x;�:-Minimumti enF 1 ,i: �._..r,. �... • - f�tr
<br /> � t;_y a,�,�x,i x.�t� �(;,;O��,woti�tn�mcl�y,s�after;subiriiE(al`daCe FR,equlied 6n'sffe;'Con"strucBonsPlans;.Stortnvirater'Rlan`s w/Silt Fence�instaited,�
<br /> ��"' Sanitary FadltUes 8�1�dWrnjpste_r.�;Site�WorkkPermit for subdivi'sions/large?proJects,s:`�.��;:;;'. `'V �.�;;.`,-'�' - �%J - � ,
<br /> __ GOMMETtC!I A#tach{3}complete�se#s of'SuiC�ing Plans p4us a i,{fe Safety Page:('1}set of Energy Fatms.R-O-VY Permt#for.new:cons6uG816n.-' � '�-
<br /> MiNmum ten(1 Q)working days a�#er submittal date. Required onstte,Construction Plans,Stonr�wateF Plans�ml SIit.Eenae insEelted,-"� �-
<br /> . � Sautilary Fedlttles&1 dumpster.Site Work Pemtik for e�U naw;pmjlacts::All commercial_�equirements_must meet complimnce` " �
<br /> . SlGN i�ERM! AttacFi(2j"sefs of"Eiigine"e,;(ed;;Pla�s:i;,�;;a�::�73 ,. .n�=: .,°ri:.. ..- .. _--_ =
<br /> "'"PROPERTY SURVEY requir�„fpr 2�II NEW�cQrlstruc,0on.,_,� .. . �- _
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<br /> t3i�eatlan�: I ..-,r��,::�.s.,,:� .,.. _ ,_. .. - - �. .
<br /> F(If out a pltcatlon oompletely. �
<br /> t}wner �Contractor sign back.of appi[catlon,notadzed �
<br /> ifover�;500,�Notice,of Cammanceme�t is r.equtr�ed. (A/G apgrades over 5�500) •.:. ,
<br /> � s<:�x.;��+�,."��fi�`�..
<br /> Agent(f�r the cantr�ctor)or_Powe�of Attomey(fbr the owmer)i�ould�be�someone wiith Nnotarized letter from owner authodzing same
<br /> OVER,TiiE.COUN�R�.PEttMtTfiNG��--�:���(Front�ofApplEca#ion-0niy)•-•-•-
<br /> Reropfis ffshii gles ,SewersM Service Upgrades A/C Fsnces(PIoUSurvey/Footage) _ _ _,.
<br /> . .. P.. ; ..„ ,.� '�'e. �,S�.tw ,:xr��:•.-:S,. _.^t -. �r.y�� r�S ,
<br /> tlrivew I ya-Not aver Caunter if on pubtic roadwa�s needs ROWr;. . .;�,. �'s
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