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<br /> s�s-�saoozo City of Zephyrhills Permit Applica#ion Fax 813-780.0021
<br /> ~ Bullding Depariment
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<br /> pate Receive , J,� — � �'—.� G -( , �n _ ��-�-
<br /> Phone�Gantact'for:yFerrntttfn
<br /> Owner's Nam� �����e '`J���°'� Owner Phane Number "
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<br /> r Owner's Addr ss ��'q12 N�6 � �� T' ��'��-- ' Owrner Ph'ane Number•.•�
<br /> Fee Simple Til iefioider:Name �� � ,� Own�r Phone Number �� � �
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<br /> Fee 3lmple'I`il eholder.,Addre�a ' �
<br /> sas�wor�Es; ��T .� � S�' S �^ LOT# ��
<br /> SUBDIYiS10N r�� ��""� F!J4RCEi..lD# � � - •
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<br /> � , , , (OBTAINED FROM.PROPER'TY,TAX NOTICE)
<br /> WORKPROP' SED , .x-NEW�C0145TR . ADD/A�T �� SIGIU' `Q � ` Q DEMQ1:l3H
<br /> ,, �IWSTALL. � .. REPi4iR
<br /> PROPOSED?.�S� . � :C] SFR [,� 'COMM ' , � �Q7HER'
<br /> TYPE OF CO I STRUCYiON �� Q" �r BLOCIC '' [� FRAME ' [,� STEEL 'Q
<br /> I � �"'� $ • _
<br /> DESCRIPTION OF WORK' -� ` .
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<br /> I � ��: � . ..,��._�
<br /> Bt!lLDING St E=`���� �'SC!FQQTA�E HE1GFlT
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<br /> QSUti DlNG � �_.—����. _� VAI.UAT10[V�.fO�:TOTAL-CONS'FFtUGT10iU . -
<br /> [� GTR{CAl �$ @����, AMP SERVECE. � Q' "�PROGRE$S ENEFtGY � W:R:E.C.
<br /> , •1.�....� , . �
<br /> QPL�MBING� $ � . � '
<br /> � r .;��� � �, � �
<br /> QME Hi4NICAL $ Vi4LUATIONOt';[it1ECHAFIICAL-!lVS7'ALWl'IC1N. �,�
<br /> ... , , . . „ . . . , . , .
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<br /> � [� , ROOFING ;[�; • SPECIAI.TY:::�;...;OTHER�; � .
<br /> FtPi1SNED FL�• OR Et�EVATtl3NS ��� FLOOD ZONE ARE�4 [�YES. _.NO
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<br /> _ ,,� _ ...�-.i �tti.et -i�:.i
<br /> BUILDER CflMPANY, _ .,___�. � � , _, -
<br /> SIGAIA't'tIRE REGi3TERED ` Y/ N ' °�"'FEE CURREA" ° Y'/N" : ' '
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<br /> Addre�si . ,•. + . - „ .
<br /> ,�Llceiise�#` `>�'_�_,�4 ':
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<br /> ELECTttIC _ � y� �� '��----, ... .� :1`'�G..ONIPANY�., ��j,r.;?,!S��fi;,���c�Lw' „'-S'�"`!-^=� , - ,
<br /> SlGNATURE. � . ; ; �: _ . ,
<br /> � t�REGISTERED Y/ N FEE:cuRREh�-' ' Y/:N�'
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<br /> ABdressl' �$ �� . 'i;r:,,�.:LE,cense;#..�, . �'..�, a��.��
<br /> PLUMBER �� . .. .. ... : �z:. =.r, ,.:;.:.: . , � . . - ,
<br /> .! . . . ,GOiI�.P..Al�lY .;:.-�Y... ,�. ..;..: . :,_, .; .
<br /> SlGNATURE'' � � . .. - - ;'`=REGIS.TERED ,_Y_/,.N:.a -�,F�-cur;tREn:�� Y.�/N, -
<br /> - - - �, . -. , . ,, a, ..
<br /> Address I � ; .. _; , . � -�. . , "�~R,: �^ . ��-'r _ . . , . . ,.
<br /> � - - .. .. . , . . ;.�tcen§e# ��. .
<br /> ,za.x_.
<br /> MECN�►tdICAl�:` ,,, . . /►� ���y . .; . -,t -�; . . ,
<br /> . V���M[. .-� ::;. c, f
<br /> StGNATURE�� - :' .. " ` � _ . y ; ' ' ' ' " + REGI§TEftED . Y/.N FEE CuttREn.. Y/�N'.
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<br /> Addrea�;� w. �'F �- . ,,f. ., .,:.-� . .. � _ , , . , ,_ , . „_ ` ;(,��.,� . � �
<br /> �tcense# �
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<br /> OTliER - ..,. ... , , ,. •�,: _ ( ,;n:,�., . . . r- , - , :.- _, _�-. . , , ,
<br /> ,GQMPANY' - ,
<br /> StCaNATURE._ . .,�. ,�x:. •.� �<.n �,� . � •f ¢a._ ...�. , _ �
<br /> t REGISTEREU Y/ N:..,: ;FEE�CUi2REA�� Y/N
<br /> +'lN{��$$�. .�� Prn.��.¢„f. '4;.e�y ��'�a�.:.ir_ . . i{M ... ., .-_-'•.,� .3- .� :.c:.�: M1 . .� _ .�.. ` :r,^;: :.;�...�. .....�
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<br /> RESIDENTlA�.; _�:i4ttaicti.{2)'Frllo Plaif :2 , � ' - - '�-,�,;^" .� `",,s:;�p,.;., . , >-`r ,s� � ., ,,._ ,: .: - � ,
<br /> _ .F :� s;;( j sets=of.=Bu�ltllrig�'Plan's;�('!)set'of=Energy�Forii�s,=R'0=t+1t�PeriniEfor new co"'nstruc�ton,r
<br /> �!�.,��.;;.:tVltnlmumt�en-�{t1Aa�wott�ing;de�ys aitarusybinititai:date:.:�Requlred oristfe;:�Gonstiu�c�tlon:Plans;�Sfomiwater�?lan`'s wl Sitt fence installed, �
<br /> = - �`Sanita'�'Facllldes�&;�1 dum ste,r•;Site°Work Perm t;far,sutidiy(slons/le�� "t ` � � ` •
<br /> rY .. �� , P , r,� .� .. ,. ►'8e:pro]egts;p.:;=�;,:�: . :� ::••:�.` �: : ,. ;J.
<br /> COMlWEltC! Attach 3'�i�om'Iste se'ts°of'Buiidln`"Plans`"��lus a�Cffe Safei"""Pa'e;��1 set of Ene Forms.R-O-Wf Pemttt far navi%consttuc#ton.• '
<br /> ( )r..;� p . 9 P 1Y 9 '{ j r£�Y '
<br /> Minimurn ten(90}woricing days after submlttat date. Required onsite,ConstrucNan Pians,Stortnwater Pians w/Silt Fence instailed,
<br /> Sanifery Facllitles&1 dumpster.Stte Work Permik far all new�projects'r:All commercial re,pulram�nts_must meet campliance • ' -
<br /> _ 5lGN PERM! AttaCh"(2}"sets of�Eit i'neePedat?(a�S:,� _.s�:� ., ,�:� -��<�,� _ . .. ,' � .
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<br /> , "*"PROPERTY SUFtVEY requ�i red fqr ali NEW corlstrucHian.--. -- - "
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<br /> L?IraCtlQttB: I .._���rN,�:;y;:;.':_ , �� .. .
<br /> Flil out a� ticatlon completety.
<br /> Owner 8� ntractor sign back.of appltcatlon,aotarixed
<br /> If over � D,a Nottc�of.Camrrte»cernent la r�qalred. {AtC upgr�des over ST500} ,
<br /> .. � tr:�,.-���,;�,�';,,.
<br /> Agent(fo flie contractor)o"r'Power"6f Attor"riey(for the owner)would be sameone wtth�note�ized letter from owner autharizing same
<br /> OVER TFiE C�UN7'ER:.P.:ERMtFfiNGri., _,.-,..(Front�of-Appllrstion:Only} _..___ , . ...
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<br /> Reroofs if shin$les Sewers Servlce Upgrades A/C Fences(PIaUSurvey/Footage)
<br /> _. _.__ � __ ..._ ..... _, a._ ._ - - - _ - ,-,�:
<br /> ' Dtivewaps-Not over Counter if an publio roadwiaps::needs ROW' � � ' . , .Y , _ �
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