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<br /> s��-a`aaooxo City of Zephyrhills Permit Application Fax s��-�so-ao2�
<br /> @uilding Department
<br /> � . '
<br /> Date Receive �`�,,, f G� 1 lr� �D _ �6 7�
<br /> , � 1 r -!�� f� €.Phane'=Cont�ct for,�Perniittin .7 . � °
<br /> Owner'a Nam �f�-�- �V�.-<' V�.1( Owner Phane Number �
<br /> e Owner's Addr ss r�:9��� N�6 '� S� /,`���e.. (K.�`,/- . Owner Ph'one:Number �� �
<br /> Fee S(mpie T( eholden�:Name �� � � ' Owner Phane Number �� � �
<br /> ��
<br /> �-�, -
<br /> Fee 3lmpte Til eholder Addresa _
<br /> .lfl8 ADUFtES, �� �J 1 S � LOT# C_w�
<br /> sU�D}V�s�ori. f s"e-e G�'— ��cE�..lo� ' . � _
<br /> � �
<br /> ' (OBYAINED FROM.PROPERTY,TAX NOTICE)
<br /> WORK FROP Ed ��NEw CONSTR ADDlA1.+1' [� SIGN` 'Q Q �DEMOI:ISii
<br /> . , .. �,.e, iNSTALL 8 �...REPAIR �
<br /> PROPQSED: $E .,.. . - �J • SFR. ' [� GQMM . � �QTHER'_ . .
<br /> TYPE tJF CO I 3'fRUGTiON •" Q� �'BLOCK r [� FRAhAE ..� 'STEEL 'Q
<br /> DESCRIPTiOA!OF WORK,' � •. ���`� P`�t"�'� �e�C.:.. D�e �ov�e,� -
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<br /> BUtIDfNG�S!i `�� ��$Q'�EOOTAGE,�: .HElGH�'��`�
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<br /> QSUlI.RlNG $ . .,. � , � _ ..> ' ,
<br /> . , VAL.UATiOt+1'�OF'TO'i'AL-60NSTR1IG'CIOPt -
<br /> ,. „ � „ � .. ..
<br /> EL 'CTRICAL ' $ _Q�d..,�� � AMP.S�RVICE. ' � �:[� �PROGRESS ENERGY � W.R.E:C.
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<br /> [�PL�MBIN4� $ ' � ' � .
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<br /> [�ME�HANICAL $ � ' VALUA710N OF,MECFIPIlVICALlNSTi?►LLATION: �
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<br /> C]�I [� , RQOFING ;:CI,�,:�_ SpEGIAI,T!;.� .. ..�THER�, .: . � - �
<br /> FINiSHED fl� OR EI.EVATiC3NS ��� FI.00D�43NE ARFr4 QYQS. ,NO
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<br /> BUlLDER COMPANY''- _ .��:.�`•�.-`- . _ , - ,
<br /> StGNATURE REGISTERED- L Y/ N •'"`-�``�EEE CURREA=' ' Y�/'N � '� •
<br /> 'k,14 -�c�5 . y:...i�` 1'�: �
<br /> �t�rBSSI :: ;�: _ i., . cr�;.j � _ ��{C@t1S8.#'� '[ !• -_�. ...". , ' , .
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<br /> SIGNATURE � '�` �REGISTERED � Y/ N FEE:CURRE�;� ' ;>Y/:N. ' . ` :
<br /> ' �y oc;;,,�.. '�i�' .. �� . .: ' • ' ` '. ., . _ ``;�!.; ,; , ' i. r � �
<br /> Address i l`r.� v� � :,1-`` s .. � .�:' : � :l.lcense;#�;_ .�::,.•,>,:13�c'.��",-�j'`�'C�
<br /> �tµt'fFl.j.ief:�,! _ -
<br /> PLUMBER '-� ' ,. , ... . , ' � ,G�MPANY . _r;, `.'''�� �� � . , .
<br /> SlGNATtlRE''�` "� � � . - ,, �riE�iST�i�o , ,Y•./,;N,; ;_ -tlF��CURREns�< '1f-7N. <
<br /> Addr�eas � N � ... . ., _;,-;, `�-0 �. - -. _, r
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<br /> C .�C811S9�# r,t...:._r`P,r �-
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<br /> MECHANIC ., .,:<; ' � , .. ,. . .. ,,. � . . �;. ,�; � . �
<br /> StGNATURE� ,:� ' .. ,.�. � .. . _ _ , C�MPANY. . - .: � ._;�.,�,..,,
<br /> '' ftEGiSTERED Y;/.I�I' FEECURRE��= �Y./;N
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<br /> Address. ._ .. . >,.�- .:J _,:ir", .. _ , - �� t « � �
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<br /> 07HER �.,,�.( , .. -.� . _ _ , .,. .. � �•� _ ..;,, ,. .. :.:�, , , ,. , _ ,.
<br /> '` ' � .COMP�1t+lY' _ ' r,-� .
<br /> SlfiaN1R1'Uf2E� ._ #�" d;� :, ., x. - . '{�` Y�.. „u , -
<br /> �REGt'STERED`` Y 1'IV;...'.: ;FE6'GURREt�• '. Y/N .
<br /> �.;�, r•; ;�.,.-�= .. . ._.. � ... �:. � ._ ..: , ..:.:- . . _ ...... : :�':°�.., '
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<br /> — 1�IC8ttS@#`��
<br /> RESlDEN71AL c; ,Altil"Ch�2 'P'!oflP 7 �. ._i . -,.. ...y. ,_::...�. � ft;�::rc�a...: � �x.�.._i;_; ,>,a... ,,;., :,,. . ..., a'�' , ,
<br /> . :( �Ip ;latis;;:(2�set"s��of8u�ldirig<P<,lan"s;('I)set=ofdEriergy;F'orii�s;�R=Q=W=#�eimlCfcir�riewi�nstrua�tbri, '
<br /> � ,;`�=Nllntmumt.#en;{;iA)wari5ingfd�ysaafterasybri�ittai'date,��eijulredon's{fe;'Gons#iucNon`Plans;`S'tdr`enwatei'Rla`'n's°wiSilt�Fence�iristelled,
<br /> Senifary Faciiltles:r&c�1�;dumpster•;,Site=Work;Permit;for,subdiv(slons/lerge?p.noJect"ss�::,;.�';�;,:;�:.."< _, ` ^+ � -
<br /> �OMMERClAL. Attech{3)`eomplete"set"s'of'Bultding Plans""pius a�t:ife""S'af�iky Page;�(1j set of�Energy Forms.R-0-1IV�Permitfar neW:cor►stnu�on.• �
<br /> I Minimum ten{10}working days affer submittat date. Required onsite,Constructlan Pians,Stomrwater Plans w/Silt Fence instailed,
<br /> Sanitary Facllitles&1 dumpster.Slte Work Permft for all new:proji�i.�t's':i411 commerGalre4aul[emen4s,must meet compllance`` ' -
<br /> ._..�,. .�._ ,.�.,....._
<br /> -=SlGN P�RMlT Attacfi'(2)"seis afEngfneei:ed%P�laAs:,,:,=.r;:�.�F - .s.- T ,.�.-.,�,� , . , , -
<br /> "'*PROPERTY SURVEY required far ett NEW construcdon.,,,. . � -
<br /> D�r@Ct10»$: ' . :�',;;,.isE..,:� , ... �
<br /> Fitl aut ap�ppp�ticatlon comptetety. .
<br /> Owner�otractar slgn back.of applfcatlon,notarized
<br /> Ef ovec OO�,a,Nottce.of Com�ertcement ia requlred (AtC upgrades aver 3T504)
<br /> � , ,. :�„*b,t::.��'f," _ � -
<br /> Agent(far�thevoontra,ctar)qr'Poviie�af'Attoriiey"(for the ovuner)wiauld be someone with notarized letter from owner authorizing same
<br /> , K3VER�TNE_C UNTE�i�PERMETf,ING�. _,�:�-{Front of Apptica#iorr�Oniy}...___. , _-�� .. � ., .
<br /> Reroofs if shtn i les Sewers . .Servlce Upgrades A!C Fences(Plat/Survey/Footage) ,_ - . .. f
<br /> . ry�•{.;r�.,
<br /> Drlvewa -Na#over Gounter if an pubtla roadways.iieeds Rtil+V ' ' ��, .
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