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s�s-�aaaa2o City of Zephyrhi�ls Permit Application Fax-813-780-0021
<br /> I � Building Department
<br /> Date Received � �a a 7 i c� Phone Contact for Permitting I� /C1� — (I�V ! I
<br /> Owner's tdame �� c U.�� C 1� Owner Phone Number W17 'a�W"�(o��
<br /> Owner's Address ��1 Q r �� ��'�-�� �h 1 i� `a Owner Phone Number �— �
<br /> Fee Simpte Titl�hoider(dame �� �1 Owner Phone Number � �
<br /> Fee Simple Titi'eholder Address
<br /> JOB ADDRES � ��O t,� �C �- t� f�l I� S� �! ��+J y� Li�T# �___r�,_�
<br /> SUBDMSION � � PARCEL ID# �1 -a�-a i -r�a1� '� �q J�t� "V��v
<br /> i (08TAINED FROM PROPERTY 7AX NOTICE)
<br /> WORK PRQP SED e , NEW CONSTR 8 AE3DtA�T � StGN � � Q DEMOLtSH
<br /> { 1NSTALL REPAIR
<br /> PRQPOSED USE Q SFR Q GOMiVI � OTHER �"
<br /> TYPE`OF CON�TRt1CT10N [� BLOGK • Q FRAME 0 STEEL Q
<br /> DESCRIPTIOFI OF WORK �QI� tJM" ���f� ��S {�QI�PS ri t`t� 1)' � SC��iE (� t��`lt� �� ����OIc�� I
<br /> BUILDlNG SIZ� � SQ FOOTAGE•L��•Y�} HEIGHT � �
<br /> u� ���� $ , j„�a ,b� VA�UATION'OF TOTAI CONSTRUCTION
<br /> �P'
<br /> �.�ELE TRtCAL � � AMP SERVlCE Q PRQGt2ESS EiVERGY Q W.R.E.C.
<br /> QPLU 81NG $ �� �
<br /> � ,
<br /> QME HANICAL � � VA�UATION QF MEGNANIGAL INSTALLATIQN
<br /> OGA Q ROOFING Q SPEGIAlTY � OTHER
<br /> FINISHED FLOOR ELEVATIONS � � FLOOD ZONE AREA �YES NO
<br /> BUII,DEl2 � COMPANY
<br /> SIGNATURE i REG�STERED Y/ N FEE CURRE� Y/N
<br /> .....,
<br /> Address! License# � �
<br /> ELECTRI.CI COMPANY
<br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address License# �— p �
<br /> PLUMBER „ COMPANY
<br /> SIGNA"fURE REGISTERBD Y-/ N FEE CURRE� Y/N
<br /> Adc3ress` License# i �
<br /> ` MECHiRNIGA4. � COMPANY
<br /> SIGNATUi2E REGISTERED Y/ N FEE CURRE� Y/N
<br /> ��«Ss'� License.# �— �
<br /> � ��,� ,, .
<br /> OTHER� ' .: �,� � � t�L� COMPANY lCOD*'� �L
<br /> SIGNATURE': REGISTEREp Y N FEE RE� /N
<br /> Address;. ���, � /�i��S � ' 3���� �icense# ���!J ���.S �
<br /> ; RESlDENTlAI!',. Attach.{2),Plot'Pians;(2j=se#s of Building PEans;(4)seYof Energy Foirris;R-O-W Permlt,for new.construation,
<br /> - ,,.; Minimum;.ten�.(:16}working days aftersubmittal�dafe. Required onsite,Con'struction Pians,Stormwater Plans w/Silt Fence installed,
<br /> � Sanitary;Facili6es.&�1,,dumpster,Sife:W,ark Permit for�sutidivisionsAarge proJects
<br /> °- COiVtNlERC! Rttach�(2)complete"set§�of Suiiiiing Plans ptus a Life Safety Page;(1}sef af Energy Forms.F2-O-W Permit for new consfruction.
<br /> � i Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Starmwater Plans w/Silt Fence installed,
<br /> � Sanitary Facilities&1 dumpster.Site Work Permit foc a!I new projects.All commercial requirements must meet campliance
<br /> :-StGN RERMt i AttacFi'(2}sets af;Engineeretl Pians. • - _
<br /> **"PRQPERT`f SURVEY required fot aII.NEW construction.
<br /> Directions: - '
<br /> i Fill out appiication completely.
<br /> � Owner&,Contraotor sign back of appllcation,notarized�• � '
<br /> if.aver$2500,a Notice of Commenaement is requlred. (AIC npgrades over$7500)
<br /> '" Agent(fo�r tfi'e=cont�actor)or Pawer"of'Attomey(for tFie owner)would be someone with notarized letter from awner authorizing same
<br /> �OVEE2'7'HE C,OUNTER PERNi1TIlNG (capy of contract required}
<br /> Rei�rmafs if shi gles Sewers ,,�.,,�,ervi�Upgrades�'A'IC Fences(Plot/Survey/Fo tag ) •��^��°°���"`"r'�'�'�;:"�����'Y s���
<br /> _ � ' ,;,�.;^'l.;;V';�; t'.:v^„ •',ti,�. - , O e ,:; '�'i�;:�"( �,:11tti'{ a7�P.11�ns"' � Y�`:� �a''�
<br /> Drivewa. -Not over Counfe�;if,on pubtic�roadways'.:needs ROW� , `""""'''`;'�' }`�"" ` ����� , •p.'r'�,t _�
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