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<br /> 8�3- so-oozo City of Zephyrhills Permit Application Fax-813-780-0021
<br /> �• Building Department
<br /> �' -
<br /> Date Receive� c -Phone Contact for Permitting - ��� � 1 � – O '7 S /
<br /> Owner's Namel � ES Owner Phone Number �13 ".3 -O 7 �'J �
<br /> Owner's Address �� . �� ^ �� C Owner Phone Number
<br /> Fee Slmple Ti leholder Name Owner Phone Number
<br /> Fee Simple Ti leholder Address
<br /> JOB ADDRES� JO � l � '} v� – �L IS L• LOT# �
<br /> SUBDIVISION n L P � v l.�-lG PARCEL ID#
<br />' (OBTAINED FROM PROPERTY TAX NOTICE)
<br /> WORK PROP�SED e � _ NSTALLSTR'B REPAIR � SIGN Q Q DEMOLISH
<br /> PROPOSED USE Q SFR Q COMM � OTHER _
<br /> TYPE`OF CO STRUCTION Q BLOCK •• Q. FRAME. 0 STEEL Q
<br /> � �` . ^ .
<br /> DESCRIPTIO�OF WORK �(�I C�
<br /> BUIL"DING'SIZE SQ FOOTAGE HEIGHT ,
<br /> OBUI DING $ (3oQ�' /_ r VALUATIOIV'OF TOTAL CONSTRUCTION
<br /> C� ���
<br /> QEL CTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
<br /> ��
<br /> QPL MBING $ '—
<br /> .. . � �.S'�S
<br /> OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION (� ( �
<br /> '� l�
<br /> Q.GA Q ROOFING Q SPECIALTY 0 OTHER .� l
<br /> FINISHED FL�OR ELEVATIONS FLOOD ZONE AREA QYES NO
<br /> BUILDER - � COMPANY �
<br /> SIGNATURE ' REGISTERED Y�/ N FEE CURRE� Y/N
<br /> Addres i License#
<br /> "ELECTRICIAN : COMPANY �
<br /> -SIGNATURE REGISTERED Y/ N �FEE CURRE� Y/N
<br /> Address License# "
<br /> }
<br /> PCUMBER.,, _ COMPANY= -
<br /> SIGNATURE REGISTERED Y�/'N �' , FEE CURRE� Y/N
<br /> Address License#' :
<br /> '�MECHANIC� COMPANY
<br /> SIGNATURE'' � ` � � � REGISTERED , Y,/ N : ,: FEE CURRE� , Y/N
<br /> Add�e"ss ' � • ' l:icense.#
<br /> ,:'s:. . : . �
<br /> , 'OTHER;, ,"�?� ' ' � COMPANY
<br /> ''SIGNATURE't. _� .,� _ • REGISTERED Y/ N_ FEE CURREK Y/N
<br /> ;-,r�.;�-, , , � , .
<br /> - Address-•.;, _ - - ' - � License#
<br /> `'�.�'� � 9r�.—' . _ �,.� , y'r.. . ., . �•6i�e}_:._....t'. ,' �".,4 � � i " " ' ' . .
<br /> .<RESIDENTI „,, `;At#ach°(2);PIBti:Plari's;,(2):sets�"ofBuildi�g�Plans;'(1•)`setof�EneFgy`F'o'rms;'R;0.-1NPermitfornew.constiuctlon,
<br /> _ �,r;�u,;3_:;k;�x:•�,,=:Minimum;stenr(;1U)`workipg;days afte�.�submittal:iJafe. Required onsite;Constriiction'Plans;Sto�inuvater Plans w/Silt Fence installed,
<br /> � Sarntary-,Facilibes;&,;1�dumpster;�Site�Wor.irP,ermitfor..sotidivisions/large'p�ojects �
<br /> ��,:COMMERCl/8L Attach 2 com lete'sets ofBuililiri`PI �`�' ��
<br /> , ( ) p g ans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construcGon.
<br /> ` Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
<br /> ,;:=•` " Sanitary Facilitfes&1 dumpster.Site Work Permit"fo�all�new piojects.All commercial requirements must meet compliance -
<br /> ��:=SIGN;PERMI� �AttaoFi'2"sets of;En��ineered'Plans:��_.. ��
<br /> �..�;,. � ) _�_., 9 .
<br /> __ � "'*PROPERTY SURVEY reGuired for,all.NEW construction.. _ :
<br />', '.�DirecNons:. II ;,.a�;.:.- „ �,,r ,.
<br /> '` .Fill?out application completely.
<br /> � Ouvner&IlContractorsign back of application,notarized
<br />� ' If over$x500,a Notice:of:Commencement is required. (AlC upgrades over$7500)
<br /> .v..�;,:.
<br /> i 1 " Agent(�rth'e�cont�actot)•or�Rower of Attomey�(foT'tFSe owne.�)would tie someone with notarized letter from owne�authorizing same.
<br /> i = ,„� �, , _: , ,. -
<br /> ;:�OVER:THE:COUNTER:PERMI7TING:_... .,:..(copy.ofcontract•required) ' - - ` �
<br />�� ��:Re�oofs if slit�gles Sewers � Service Upgrades NC . Fences(Plot/Survey/Footage) , '
<br />�i � ` :.�_;_.___...__ :., .r__. ..�....,:.,.� . . ' . - - , ,�...-- - .
<br /> _ Drivewa s-Not over Counter if on public roadways::ne�iis'ROW
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