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<br /> e��-� aoozo City of Zephyrhills Permit Application Fax 813-780-0021
<br /> ; . Bullding Departrnent
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<br /> Date Fdecel«d�l — j� .,.� ./� =:: Phone��Cont�ct'for P�rmittin - - '
<br /> Owner'a Namel ��1/ J��' Owner Phone Number
<br /> Owner's Addre " �� �i�i'C/ /�� �� Owaer Phone.Number�
<br /> Fee Simple 71t eFiolderNara�e � � - � Owner Phone Number �
<br /> ;,.'s. ` -
<br /> Fee Simple TI eholdet Addr�sa r
<br /> JOBADDRES �� ' t � . LOT# �
<br /> SU�DIVISIOPI � PARCEL ID# ` � •
<br /> • . (OBTWNED F.ROM PROPERTY,TAX NOTICE)
<br /> WORK PROP�SED �.NEW�CONSTR' ADD/ALT [=]� SIGN' 'Q Q �DEMOLISH
<br /> ,. ,8,. INSTALL e� .....REPAIR
<br /> PROPOSED�.USE . - Q � SFR• �] COMM ; Q •O'THER' _ ' �
<br /> TYPE OF CON TRUCTION'�� Q" r'BLOCK " Q FRAME ' :� STEEL 'Q
<br /> , , ri.. � / _'�
<br /> DESCRIPTION OF WORK' •� N /I/ r¢ il �a �r� / n/y
<br /> BUILDING SIZE ,; � ' � '' 84.FOOTAGE.��= ,HEIGHT�.� " ,
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<br /> QBUI��DING S VALUATIONrOF:�TOTAL CONSTRUCTION ' � '
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<br /> QELECTRICAL $ ' " AMP SERVICE. - ' = [�'� ' PROGRESS ENERGY [� W:R.E.C:
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<br /> OPLU BING - :$ ` '
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<br /> OMECHANICAL' $ ' ' VAl:Ui4TION O.F�MECHANICAL INSTF►LLATION. �� `�j �
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<br /> Q GA i � , ROOFING ,Q ,,. SPECIALlY,:Q;�,_�OTHER, ; . -
<br /> FINISHED FLCJOR ELEVATIONS FLOOD ZONE AREA ,QY�S. NO
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<br /> �'R � i 1, t�..���"!.'M1. A:�a. '_�_
<br /> BUILDER COMP.i4NY�. . .. ,�t�.`= , - ` - , ,
<br /> SIGNATURE REGISTERED Y/ N . ,`�%F.EE CURREK:� '`Y/N'" ` �
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<br /> Address _ �.;; 3,.:<_ .a:..;.'. , _ -;i .. ,�Ll0e�s8:#�� ' .
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<br /> ELECTRICIAN. ,. . • - ,�COMPANY'.-r _ :„� ,,�:t�.,.,.�f:�: ,_ _ ' ,,, � . �
<br /> SIGNATURE� � REGISTERED j Y/ N FEE'curtrt���' Y/:N� • �
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<br /> Address - � � - :s; _, ' -. .� . . �i � • ,. . .. ��.e ,., ,.. ..., , r,
<br /> e' _ . License�#�:� --
<br /> PLUMBER ' - . . � •� t V G.OM..P,ANY � ' �` . '.; - - � _
<br /> SIGNATURE�; - �, , . . , • - ,. , . •. :.:,.,:... ,r :,.;.:�„;..:. . ;,� �.. .
<br /> `�REG�S.TErtED _ , Y./�.N:•� .rFEE:CURREb:�: Y;�/N�:�.
<br /> Address , ' .' ' _. -,Lioe se�,#,� - • � ` , -
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<br /> MECHANICAL � , . _ • , - . .� �, , ., CQMPANY. • ,:•;_ � , _ ., . . .. .�,;.- .p, , =• " x .
<br /> SIGNATURE� � "' -� • •� " ` ' � ' � ' '"r� ' REGI§TERED ., Y/.N FE
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<br /> Address,�-. -', .. , .:.. , :°S> > . .. � �- _ - ,. . ., ., �, . r _;.� . . . . �
<br /> .I � � � „ _ Llcense# _ .
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<br /> OTHER - � ;COAA�PANY. !✓ '�' .. �
<br /> SIGNATURE• - � _ . : , ::;.., - .. . „ . - x,�.,.... �t�:-�;4, ,_. , ' .-.
<br /> ';r. ' �` ''REGISTERED '� Y/'f�F..., � `�FEE�CURRE�' Y/N
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<br /> Addf8a8' *r< � _.. � - ' - ,.r- _ ., .._.• Y.
<br /> :�J'�,�: „,� �'l r � � '�iceiise#���
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<br /> RESIDEN7IAL .,,,;Atta�cll'��.E2);P1ot�Plaris;�(2)sefs`o�'Buildfngt"Plans;`•�(;1�)set'of�En'ergq,Fortns;�R-O=W�'Peim`iE for new�constnictlon,.
<br /> �-u• ;,����>Minimum��enr(10)�,wot141ng�de�ys�a(te.r;�submlttalitlefe::sR.'equired onsife;'Constn'ictlon'Plans;Storrnwater Plane�w7 Sllt'Fence�instslled, '
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<br /> �`Sanitary Fadl(tles;&,1Edumpster-�;Slte•:Work�Pertnit;for.sutidiW'slons/large;projects;'::-_;.�°;{� � , ,_. .
<br /> CO[NRAERCIAL. Attach 3`oom"IeCe seCs�of`Bulldtn�`Plans"'�lus a Ufe Safeµ�Pa�e; 1 set of Ene� Fortns.R-04-VN Permit�for ne�y.con..ttr�ctlon.• •
<br /> � ) P 9 P tY 9 � ) r9Y c�"
<br /> -- � Minimum ten(10)working days aitar submlttal date. Requtred onslte,Constructlon Plans,Stormwater Plans wrl Sflt Fence installed,
<br /> Sanitary Fadittles 8�1 dumpster.Stte Work Pertnit for all newrproJl�cts::All commercial requl�ements_must meet compllance 'J �
<br /> _SIGN PERMIT Attacfi(2)sefs of"Enginee`ed�;Plans:;;:�•�;�=�r .. -•:�• ._. . _- --. .. � - .`
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<br /> � "••PROPERTY SUR1/EY reguira�.ipr all NEW.00rlshucUon., - •
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<br /> Dliectlons: I ..._�r�.`::,±..,f,-< .._ - . ,
<br /> FIII outapplicatlon completely.
<br /> Owner 8�ntractor sign back of applfcadon,notarized
<br /> If over� 00,_a Notice,of;Commencement ia requlred. (A!C upsrad�s ov�r ST500) ..
<br /> ����`:��_�.>;'�<�
<br /> " Agent(for the'contr`actor)or Power of Attomey(for the owner)`vvould be someone with�notarized letter from owner authorizing same
<br /> DVER�THE C UNTER:.PERMITTING���•-•-�-(Frontof-Applicetion-Only)-;-;-, :' � �" '"' � �
<br /> Reroofs Ifshin'les Sewers Service Upgrades A/C'�.;,=,Fences.(Plot/Survey/Footaga) ,
<br /> Drivewarl-Not over Counter If on public�ioadways�heeds�ROW�' '�V� � � / � � I�
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