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<br /> s�s-�saoozo, City of Zephyrhills Permit Application Fax 813-780-0021
<br /> I . Bullding Departrnent
<br /> Date Recelve •
<br /> -�I. • • �.: Phone�Contact,for:P�rmitfin ' � -
<br /> Owner'a Nam I '�(�O G ���� owner Phone Number °
<br /> OwnePs Add s� � - . - ' Owrner Phone:Number.•
<br /> Fee Slmple TI IeHolder,�Name - � Owner Phone Number '
<br /> Fee Simple Ti leholder Addresa
<br /> JOB ADDRESS � � ,�"-� � LOT# �
<br /> SUBDIVISIO� . PARCEL ID# ` .
<br /> I (OBYAINED F.ROM;PROPERTY,TAX NOTICE)
<br /> WORKPROP SED w�NEW'CONSTR ADD/ALT Q� SIGN` 'Q � Q �DEMOL:ISH
<br /> „ B, INSTALL 8 ,r REPAIR - .
<br /> PROPOSED..�S , �
<br /> II E .' . _. Q � SFR []- COMM ' . Q OTHER
<br /> TYPE OF CONSTRUCTION'"� 'Q` *>'BLOCK " Q FRAl1AE ' .Q STEEL' 'Q
<br /> ' :� :J.. ,q , •
<br /> DESCRIPTION OF WORK' � ' .Q G �Q ,,� � Ct. �I
<br /> , • . • -
<br /> BUILDING:SIZE - • �' � �'SQ�FOOTAGE�, ,HEI.GHT�.
<br /> I „, -
<br /> OBUILDING $ VALUATION�OF�TOTAL-COySTRUCTlO � '
<br /> �
<br /> [�EL CTRIGAL $ �O ' AMP SERVICE.a�� ��PROGRESS ENERGY [� W:R:E:C.
<br /> � _
<br /> QPL MBING • $
<br /> , , � �,. „ - _
<br /> QME HANICAI: . $ " � ' ' = VALOATION OF;MECHANIC�►L INSTALLATION. .._
<br /> Q�II' � Q , ROOFING Q ;, SPECIAL7Y;:r],-; „OTHER; :
<br /> FINISHED FLOOR ELEVATIONS FLOOD zONE AREA ,QY�S. NO
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<br /> ' , . . . . _ . . s.�.c,� z.:�.. � _ .
<br /> BUILDER COMPANY`. . :,`�.;.': -, , . - �
<br /> SIGNATURE REGISTERED Y/ N . ���FEE CURRE��" � ` Y/N`� '�
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<br /> Addres �: ;,°_ <M - . ,, ed - ., :Ucense:#` ' �
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<br /> ELECTRIC�, .s. �. ` ,.. , � . �}COMPANY �(���'� C� �%G:.-d;l� .�/ �� :d' !' '
<br /> SIGNATURE G� , ..� ���sreRe� Y/ N �E cu��°f ::r;�:,y�N,�, . ' •-
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<br /> Addr ,CL � '�1,..�. .. _ ,. .3,,� . ;,<<;«t %;::.:;;:;Llcense;#,� OD_!J,/,��y �,
<br /> PLUMBER ' � � , • - • ,,. _ , „' ;�, :;�.: _.. .'.;+_ . - ` - .
<br /> SIGNATURE - :, . -- , -_.C.OMPANY . �.< <..,,. �ti ,:< ., �_.. . •>�: ._.. . ..
<br /> „ .,REGIST.ERED. :Y/,N:.:�:i,.;r,��;curttte�:• , ,`y./.N�:,,,.,.
<br /> Addre � ' , � .� . � . . . _..r : : .: �:::' .� . . „ ,- .. - „ -
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<br /> MECHAIVIC Ft 'f ... " . _ .�, ' COM�ANIf, ,.,: � ' ;` .:-� :•..:=` ,�, _ -'�� - ,.
<br /> SIGNATURE� �� ^ ��'� - '� ' { - � �" � �REGI§TERED � Y/,N FEE CURRE�,._ `Y./�N.'
<br /> �I; - _ ! -- - .. , �+'' . . � . ..... .- • :� - - , ... _ , ,
<br /> Addr .,,'� :;''' .. . _ .�;.... ., r�� .. � ., .:..,o,, � , _x. . �
<br /> License#��
<br /> OTHER � � _ :- , .., , .. , - - , -:, - ,,,-� - �-.� : _ r:;. , ; _ +, _ . ' . ,
<br /> "= ,COMPANY - � . -
<br /> SIGNATUftE _ ., _ '?��" ^� .. �, . ...,. ..,1, .._ ... , . - ra .. , _., . .. , -
<br /> . ,..,•,.,a ���: �;j' . .'�. .:....:...:. ... . ., � a:.:,' „T.r�D;.., '
<br /> �'REGIS E Y/ I�F,:.. ;FEE�CURRE�•�� ^�Y Y N
<br /> �F' �ty� >, -"�+r .1.. �.�. .. ,_ . � - . . . .. .. . . ,. _. ". . .�_� ,
<br /> Addresaa ;<<<., _,r::,:° _� _ �'z: .._. . .�:,. ,. ' ��Lioense#�% " . -
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<br /> RESIDENTI �I�r._yAtta �2 1 � , .. . _ .- ,�f:-r. .;_ ��,;�.,r.�.; : � ��,�_„ ,,,t a..: ,-:<.� ,.:..::., �-- .
<br /> � ,ch;,( );.P-„ot�P.,l.ans`;,�(2�)set's�of:B'u(Idtri :Plan`s;� 1 set�of�Ene Forms;�R=O=W�Per`mlCfo�new�conshucUori,.
<br /> . 9 .�;�;:.,. �y.,.. ,,„,_, . . :_ ,:,: -
<br /> �aN�,,�AAlnimumt�enk.(;1.0)yworl4,ingjde�ys;�after�submittel:da4e:�:Required on'slte;:ConstrucHon'Plans;StomiwaterFlan`s w/Silt Fence'installed,
<br /> �` �Sanifary Fedlitles,&;�1E;dympster-;Site•-Worlc�Permit;for:subdivislons/la e� ro e`cts?:=:�-`" "' � , _ �,�
<br /> ,�: . , ,. a�. . , . .,. �',9..P}T � a���',- .ti,,;`�
<br /> COMMEFtCI Attach(3)�eompletersets'of�Bu'ildfng PIanS'"pl`u's a�Ufe�Safefy Page;(1)set of Energy Fortns.R-O WtPermit�for neW constructlon.•` > .
<br /> Minimum ten(10)wrorking days after submlltal date. Requtred onsite,Construc8on Plans,Stortnwater Plans w/Silt Fence instelled,
<br /> . Sanitary FaclliUes 8 1 dumpster.Sfte Work Pem�it for all nawtprojecCs::All commerGal.�equlrements_must meet comp0ance`" '
<br /> --SIGNPERAPIIT AttacFi'(2)'sefsofEng,i`neeredsPla�s:�;�:�:^��h:�;��:. �:;��.;c::�,�. �. � -._. .,. �- , .,
<br /> I ""PROPERTY SURVEY r�yulre�„(or all NEW�oonstructlon._ _. �, -
<br /> Dlrectlon�: II :•_;r.�e�w�,,.+,,:�:� .,:. -,- -
<br /> Fill out�ppltcatlon oompletely.
<br /> Owner&Contrector sign back of appllcatlon,notarized
<br /> If over�2500,,a Notice of Commencament Is requlred. (A!C upgrade�over 57500)
<br /> II .:,�:�:`�w�;,�;.Fc�;°,,. , .
<br /> '• Agent(f�pr the contrabtor)or Power of Attomey''(fo�the ovuner)�iivould be someone with notarized letter from owner authorizing same
<br /> OVER-THE:COUW.T,ER:PERMITTING-��•-•M•-•(Front�ofiApplicatlon-Only) •---- ' ' `" "
<br /> Reroofs If shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage)
<br /> Drivewll ya-Not over Counter if on:p�b8c roadways:needs.ROW:. � . . �. . , � � . t �,. � , �
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