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<br /> s��-�eaoo2o City of Zephyrhills Permit Application Fax 813-780-0021
<br /> Bullding Department
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<br /> Date Recelved� ,�p� /a/�� . ;;phone�Contact'�for:Perrrilttin - • — �
<br /> Own�r'a Name � �O� Owner Phone Numb�r g�3 2 ��
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<br /> Owner'sAdd II��ss ��5� W����t"LC?��� � U� • �OwnerPh'one.Number�
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<br /> Fee Slmple TItIeNolder.Na�me � � � ° • � Owner Phon�Number
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<br /> Fee Simple Tltleholder.Addresa -
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<br /> JOB ADDRESS S��- � . • LOT# � G
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<br /> SUBDIVISIOPI;� PARCEL ID# ,� �Lls r�14� �l7�CL?� MOQ JL� �S�j�51�4.
<br /> � . ° (OBTAINED FROM.PROPER7!Y,TAX NOTICE)
<br /> WORK PROPOSED <.,NEW CONSTR' , •: '' ADD/�4LT �� SIGN�� 'Q � ` Q �DEMOLISH
<br /> � ;e. INSTALL � .,. ,REPAIR ` �
<br /> PROPOSED.USE . Q� SFR• ' [�. COMM . � Q �OTHER
<br /> TYPE OF CO ISTRUCTION =�'Q"' x''BLOCK " Q FRAME ' :[� �STEEL 'Q
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<br /> DE3CRIPTION OF WORK' ���f�(' 0� T�' �T�I�� 5'To/L I�Gd , �R� �
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<br /> BUILDIWG�SIZE�'; � � � � ' SQ�FOOTAGE��, ,.HEI,GHT
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<br /> QBUILDING $ ,�r O7 YALUATIONYOF;�TOTAL CONSTRUCTION , '
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<br /> QELECTRIGAL $ - AMP SERVICE. � Q � "�PROGRESS ENERGY Q W.R.E.C.
<br /> . � . G�'.C/T .��/L 7�7���Q'rJ " - � •
<br /> OPLUMBING - $ � . . . � -
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<br /> QMECHANICAC'' . L $ ` VALUATION O.F;MECHAfViCAL INS,TACLATION: •
<br /> QGAS �Q ROOFING. ;Q, , SPECIAL7Y,:.0;� OTHER, , _ �C � �3�
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA, QY�S. NO
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<br /> BUILDER � / _ � COMP'ANY�, . - ��� �.� �' •. _ . .
<br /> SIGNATURE � � REGISTERED Y/ N . ` ;'�'=FEE eurt��.� •' °Y%N''� =
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<br /> ELECTItIC� , . . � : �}COAAPANIf' � - J� :' - ;'G .s' . : , _ ,
<br /> SIGNATURE` 1 � REGISTERED ^Y/ N FEE�cu�=.�� �_��ry'�Y/:N: : " . -
<br /> Address i , . „> _� ,. 't' . ' ' - ` � �^ ,Ll.cense�#;: ,. , ; . .. �.
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<br /> PLUflABEPt ' _C.OMPANY _ ,:,�����:i •' , .�_�;,. . �.�` �.:,.
<br /> SIGNATUREi.�` • � . . , - � ,REGIS.T.ERED =:Y./�.N;; r:F�:Cuw�rt•� �,�, ^Y..-/.N,
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<br /> Address� , , � .,. � . � • . - ._ ', -
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<br /> . - , , .Licen,sev#; � .
<br /> MECHANIC�►L`. -• ' , - - � , " COMPANY. - , : _._ _ ,. '.,.;..��::. .�;. �� , a .
<br /> SIGNATURE��I ,�'='` , ' , � . - .`' ' REGISTERED Y/.N� , .:;�;FEE CURREt�;, 'X.L:N..: ,
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<br /> Addresa;Y:'... _�. . >. -�„�, _.c�s-, .. ,. - , ��r.. :i= , • _ , .
<br /> Ltcense#� _ ,,
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<br /> OTHER '�� .. , . ,.._ ,-. . . ..,. ,' ; : - : ,;�..,,, .� ';,_ . , , , .. , ,. .. . .. _ .
<br /> � ;COM,PANY _
<br /> SIGNATURE•= _ � _ � :.,: a - . _ :> , _ , .
<br /> ';' `' �REGISTEREDs `Y/ PF:._�.. ;FEE'Cuw��'� YYN
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<br /> Address ,r,.� rK >�.�.�,��;� _ �°r _ , , .• _� ' �License#�` - , � , • .. �.
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<br /> RESIDEN't1AL�:�;;�;yAttach:•.(2)„P1otrPlans;;(2)sets:ofBu�l'dirigi:Plans;'(1�)seYof�Energy�Forins,�R=O=W,Permif#or new constructlon,, ' ` � .,
<br /> w-��;:A;�:Minlmum;.tenr.(;10•�uiroJ,R-In(�dp�Q after'submlEtal:d"af"e.`:�Rp/�ulred onslte'�Constni�'ctlon?I?lans�Stormwater=Flans w%�SIIt Fence�lnstslleil "
<br /> �,r� .'.<• ' .l' G.. } N�e .:'i Pk...`7J`.�e�. 4 �`7( � ... ' _ _ '1
<br /> Sanitary Fad�lltles_;8��7�dumpster-Slte°Worlc�Pertnit;for;subiifvislons/largelipfoJeOts'�:�''-"::;,i,„s. _ .'t= ' . _. " -^.�� - '
<br /> COMIYIERCIA,� Attach(3)�i:omplete'sefs'of�Bulldfng'Plans plus a�Ufe Safe(y Page;(1)set of Energji Fonns.R-O-W Permlt�far neW construcUon.- ��
<br /> Minlmum ten(10)working days after submlttal date. Requtred onslte,ConsUucdon Plans,Stormwater Plans wl Sllt Fence Installed,
<br /> Santtary Facllldes 8 7 dumpster.Slte Work Permlt for all new�projects:,All commercial.requl[ements_must meet compll�nce "' � ` �
<br /> _ SIGN PERMIT AttacFi�(2)"sets ofEng,i'neQr.ed%Plapsx�,:�=ir�~�°~� . .: " .. . . ..... .. . . - ' ` -
<br /> , ••••�ROPERTY SURVEY required for all NEW,constructlon.__.. . � � -
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<br /> Dl�ectlons: �; -::.���;:�:t ,_.: �.. • _ _ _: ,,. :<
<br /> FIII out appltcadon oompletely.
<br /> Owner 8�Contractor slgn back of applfcaUon,notarized
<br /> If over a2500,_a,Notlee of_Commencement Is r�qulred. (A!C upgredes over ST500) , _
<br /> i . .�:--,.�:.n�_;;:-;;a;
<br /> " Agent(for the cantractor)o�PoYirer of Attomey(for the owrier)would�be someone with nota�izad letter from owner authorizing same
<br /> OVERTHE.CAUN.T.ER„PERMIT.7ING�-•-�;•-(Front�of•Application-Only)�--•--� ' ' �
<br /> Reroofs If shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage) '
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<br /> Drlvewaya-Not over Counter if on publlc roadways:.need`s ROVV • ;,,;;��� ,��; �,�,.��,;,::,,�;�,-, ,��•���, �,
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