|
�
<br /> a� �-�$�0�4 City of Zephyrhills Permit Application Fax 813-780-0021
<br /> ` � ' Bullding Depa�t►nent
<br /> 1 . .
<br /> � -
<br /> Date Recelv�d " . `Pho�e=Go»tact'for°Permtttin � -
<br /> Owner's Nar�ile ��- � c +'���`� �� . Owrner Phone Number �f� `24,5��.3(�'..{� '
<br /> Lrjw � ' �
<br /> Owner"s Add�� ss �� �� �� ,�U2T OwnerPh'one.Number
<br /> � ,. _ . . , ,_ , „ ,_.,
<br /> , ,
<br /> II �`
<br /> Fee Slmpie TitleHolder-Name � � I ' Owner Phane Number � � �
<br /> �! _ .:s . - ,.
<br /> Fee Simple Yttleholder.,Addresa -
<br /> J08 ACIDRE��$ � t�.L �� �(� � � � � �t�;,� � �� ~ � �L LOT# C_,�
<br /> sueoEv�sio, � . �� �aRCE�..��# °1 f - � �1� � 1S'�ao a/ 7� .
<br /> . • (OBTAINED FROM,PROPERTY,TAX NOTICE)
<br /> W�RK PROP II SfD .` . ej �,N TALL�� .r,_RERAIRT �� SIGN` `Q ' Q •DEMOI:ISH
<br /> PROAOSED�USE � Q 3FR. �J COMM , Q •OTHER a �v� _ '
<br />, TYPE OF CO�STRUCTION � Q� �x��BLOCK ' [� FRAME � .C� `STEEI. `Q
<br /> 1 ' .- �.. . _. � -
<br /> � •
<br /> "�. � � fl r1 t�t cn...
<br /> oFsct�N�no�oF wo�K� ' ti.a� � �'c D -{: s�t� i� n/P l�-�ce,� � � T' �
<br />' BUI�DING=SIZE"� '� ��SCl.FOO'i'AGE,�^�: ,, HEI,GFIT.�C—_____� -
<br /> ry . <<
<br /> , . ., . r.
<br /> li -,. .,,
<br /> , ,,,_, _
<br /> �$U� 4{ ���' $ L Z,�11. A� VALUATiON3tOF'TO'!'AL CONSTF2l1G'i'ION - � ,
<br /> QELE.IGTRiCAC $ ' � AMP SERVICE. �] �PRtOGRESS"ENERGY Q W.R.E:C. �
<br /> [�E?LUlVII BING- $ ' . � ' ��
<br />� . � s,. - :.
<br /> �„]MECI ANICAL- , .'$ . , VAl:l1A'ClON OF�(VlECMi4N�CAL INSTP+LLATit?N: �"��
<br /> : � ; , j: > _,. . , .�
<br /> I [�GAS - RQOF,ING Q; ;� SF?EGIALTY�:C];�. ,.OTHER;.. : _
<br /> F�NISHED FLOOR ELEVATIQNS ��� FLOOD�4NE AREA QYES. .NO
<br /> I� .� . `t , , - .:��..� .y.''���,. -_ .p;,..#..-.,� . -.. ,r'.
<br /> 1
<br /> �u��.��� coM�A�nr�x . __..�:<.��:� __, . . .. � �
<br /> SIGNATURE REGISTERED Y/ N �`'EEE CURREK%" ' Y'/'N �
<br /> t�-. `.v . 7�"'.. .-�`:' _ . . _.
<br /> I Addre�s �}. � :<� '�� r ��Llceitse`=#' „t r `
<br /> � r�
<br /> ; .I � .�, i ... � a. .. .�y � � .. .. r... .. � . .. _ - . . .� �_ .. . .
<br /> Ij ELECTRICIAN; . , . , , - `t?CQMPANY' . _� ""3 "}=.i°i?::F- _ , � , '
<br /> , SIGNATURE � �t��is7eReo i Y/ N FEE:CURRE�*' � ^��==Y/�.N' ' ' -
<br /> � Addre�s' .. _ ., . ' -,. , ._ ;,� . ,-_. . � . . ` .�i..�.s.�Ucense:#,;�: -�: .�: �," 1
<br /> , �y' .h�,✓�S%
<br /> I . , a .' . - . r _�1 '�`S"�":u � e � T� � .� � "
<br /> ( PLUMBER�` ' . _. - � ,., CQiVIPA�fY�, -..-.�:..,:�.. ;� v �s,;��, ,;. _,: : .._` , - .
<br /> SIGNA'TU1tE°` ftEGISTERED . , ��Y•.-/,.N,a ;:;�.FEE-CU��tREn;•� , . Y�/.IV�
<br /> ( , , . . �,�, , .,:, :.. . . . . , ,r, �
<br /> Address i��censeY#� � ������ _
<br /> . .. , ., s ��!:
<br /> � .. . - - , " " " ' ..-, . ' :1'�. ,54 �� , y '
<br /> �MEClfAi�llGAF:` �� .� • • _ „ � �- '' � ' �G,QMPANY � �� � ..=.�ti,.� . : .
<br /> SiGNA7URE� �''^ ... , � � _ „ • � "'ti� � REGiS7ERED Y„/.N 's.FEE CURREM1.. -Y./:�d �
<br /> .,. . �I• - _ "�:" . ... . :",�. .w.,• ra ,, . ,..
<br /> t�. - - � : ' � i. � .� '°L� i .+xi q.,� , .�� . .f �
<br /> AddrB�sv..-- ��',"`- - ,.,., rt � - - �IC8ns8#`�
<br /> _ . ,,�,..,,,
<br /> _,.,.. �- t;ir �c-r�... , r sio� �`'�,,:"•.� �'�� .� .; .�;.Kt`',.,,��.,. C�-,gsln��r �' �C SR/C'
<br /> OTHER -rr= �- .,_ ' ' - ,COiIlIPAt�l1(` � _�,..... __ .
<br /> � ,,.., �.> ;, _ .
<br /> SiGNA'1'tIRE•: .. � _ ' ,��`- '� � � `RE�is'rE�'` ` ` '`l/'N:w ->�E'Curi�n� Y/N.
<br /> �a��:, ��,: - vf�e� � ,�-_ . . . u�n�����{�'��#,�3��a-3 Qo � - .
<br /> ,.� - -
<br /> ,,�. .,,,.t T.a .��, ., .:..,.,;.. ,
<br /> .RESfD�NT1At:' ^ 'fAttacti_ r i •, ..,_ �.. ,,..-..: . .. �; � .,,- r. • .:;>. �.:,:.
<br /> _�,�,:, �(2)�fofPiaris;:=(2)selsr�f:BuildfngPlaiis;{�)'set'af�En'ergy:Fo�ns;�R` NtuPeimitEo'r`-new�constriict�ori, `
<br /> ,_,;���Mlnimum�t�enr(10)>wori�iny�de�y,"s�after,"s`u"briaifta�'dafe:'��Requlred onsiEe;:ConeWction:Pians;Stonnvirate'r'Rians�w/'Silt�Fence"instatied,
<br /> "'���!Sanite.`ryFacilttles�&�.�1.;du/�,pster-=Site>Worlc�Perm(t;tor;'suk►�ivisionsAarge;p�rojec"ts�,�`:w:��;��,��'• ";�:�;�y' " - -. ` `
<br /> � Z ;�S) Y Jn, . ......t't _'.1r.Y..n.....�'J.... �..iA'F»3 ' " i, L. v.��
<br /> COM�tEttClAi. �At#ac�{3)�t�in`p18te'setstlof"Bul[�ing Pians'plus a Ltfe Satety Page;{1}set of Energy Fomts.R t?-VY Permit tar nsW:oonstructlon.� , ,
<br /> �Minimum ten t10)woricing days after submittal da#e. Raqulred onsite,ConstrucNan Plans,Stormwater Pians w/Sitt Fence instaited,
<br /> �Sanitary Faclltdes�1 dump'ster.Site Work Permit for all newtprcjects:All commerclal�ulrements_must meet complfencs �"� �
<br /> SlGN PERMIT ' tiacti{2)"sets of�itg,[neeced,t?la�is:�;�,��:'�; R , .. :.._ . _ ,._- t . , -
<br /> '°""PROPEFtI'Y SURVEY reyui�ed fnr all NEW corls_.y
<br /> II truction...... . _ - _
<br /> DIiBCtfotlS' h} •-.-^'�=�$a�"fl. :-
<br /> FIII out applicatlon compl�tely.
<br /> Owner 8�Conhactor slgn back of applfcaban,notar�zed
<br /> 1f aver�2Sb0._�.Notles of Comme�c�ment i�rsquired. {A1C upgrades aver$T500} , .
<br /> ..w ;,z,�.:,,..,,�>� ,..�._... .... � .
<br /> �. �.��:•.
<br /> Agent(for the'��ntractor)"or"Power of Attomey'(fair ttie owner)`would be�someone with natarized letter irom owner autl�orizing same
<br /> DYER'TNECdUtifTER.PEttMtTT1NG--�,_..:�-{Front•of•APPlIcatIon-Only)-�---
<br /> Reroofs If shingles I Sewers Service Upgrades A/C Fences(PIaNSurvey/Footage) _, ..��
<br /> � ._L_. .._.,_. w...__ _ _ �_:,;;'� I
<br /> Orivsways-Nat�over Counter tf on public roadways:.needs ROW ,
<br /> I
<br /> �
<br /> 'i .�., ,,.,'�.
<br />
|