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<br /> 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
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<br /> Date Recelved
<br /> i Phone Contact for Permitting • —
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<br /> Owner's Name � • Yl rl � !� , Owner Phone Number , I
<br /> Owner's Ad I�ess . J 0 �� Owner Phone Number �
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<br /> Fee Simple Iltleholder Name ' Owner Phone Number
<br /> Fee Simple�tleholder Address
<br /> JOB ADDRE S �� d ( l �v) J T LOT# �
<br /> SUBDIVISIO PARCEL ID#
<br /> (OBTAINED FROM PROPERT-YTAXNOTICE) �
<br /> WORK P.ROP SED e ._ NEW CONSTR B ADD/ALT Q SIGN Q Q DEMOLISH �
<br /> INSTALL °REPAIR
<br /> PROP,,OSED ISE Q SFR Q COMM � OTHER
<br /> TYPE"OF CO STRUCTION Q BLOCK •• Q FRAME 0 STEEL Q �
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<br /> DESCRIPTIO I OF WORK �'L(J� l2, _V( L�S
<br /> BUILDING.SIZE SQ FOOTAGE� HEIGHT ,
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<br /> QBUI��DING $ VALUATION'OFTOTALCONSTRUCTION
<br /> �ELEII TRICAL $ / /� AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
<br /> (j�V(�� `�J '
<br /> QPLUMBING $
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<br /> QMECI ANICAL $ VALUATION OF MECHANICAL INSTALLATION g
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<br /> QGAS Q ROOFING Q SPECIALTY Q OTHER L �
<br /> FINISHED FLO R ELEVATIONS FLOOD ZONE AREA QYES NO
<br /> BUILDER COMPANY
<br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address License#
<br /> "ELEC,TRI,CIAN COMPANY vl � � r[G
<br /> :SIGNA7'URE REGISTERED Y/ N `FEE CUf2RE� Y 1 N.
<br /> Address � :� 3�. ar G d"�3�� License# � � (��,3"�3
<br /> PLUMBER,,,,,, COMPANY , � �
<br /> SIGNATURE REGISTERED Y•/ 'N• FEE CURRE� Y/N
<br /> Address L(cense#
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<br /> MECHANICAL � COMPANY
<br /> SIGNATURE'' � I REGISTERED Y/ N FEE.CURRE� Y/N
<br /> Add�ess�•� ' � License.#
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<br /> ;OTHER�=-"'.:" � COMPANY
<br /> �`SIGNATURE;�� ;=� ,� - ' - ' �REGISTERED Y/ N. FEE CURREK .. Y/N
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<br /> . Address�- I - • � ' License#
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<br /> ->•,RESIDENTIAL<'� 'A h 2 iPl"� ,
<br /> _ .. ,,,,_ , , __ ttac__r(. ), of':Plans;`'(2)':sets=of=Building�Flans;(1•j'set of�Energy_Forms;R-O=W Permitfor new.construcbon,
<br /> .�".t, ,,. ;:;y:,�;�r.����.I.vMinimum��ten.�(>10)working?days after"siibmittal��ate.�Required'`ori'site'r ConStriiction Plans;Stormwater Plans w/Sllt Fence installed,
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<br /> ,;,fi.\�;.� , �� ��` � Sanitary.tFacilities,8�f,1.;dumpste.r•;,Site,War,k R.ermit for subdivisions/large pr`oJects � >' � , ' _ __
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<br /> COMMERGIAL I Attach'(2)'compiete'sets of'B`u(Iding Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construcdon. _
<br /> '' "`` , Minimum ten(10)working days after submi�tal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
<br /> �"�' �Sanita Facilities�1 dum ster.Site Work Permit fo��all=neuir• ro ects.All commercial re uirements must meet com liance
<br /> �.::- rY . ,P_, _ P 1 q P
<br /> �`::SIGN!:PERMIT 'Attacti(2)"sets-of,Engtneered;Flans:��- � : � • - '�
<br /> l�i�.:" ' .. �
<br /> ':;>:;�,_ 'i"'"•PROPERTY SURVEY required for,all,NEW constructlon:�
<br /> '�'Directions:, II._.�,.-. �� .,f�.;�;��',-.. ,. . -
<br /> ''°:-`�= F(IG:out application completely.
<br /> .. �Oiivner'B�Con�raCtor sign:back of.application,notarized
<br /> If over$2500��.a Notiae:of Commencement Is required. (A/C upgrades over$7500)
<br /> .�`_'� A ent for�th`e��conVactor�orFower�ofAttome for`tFie oinrner would tie someone with notarized letter from owner authorizin same
<br /> - 9 � , � ) Y� ) 9
<br /> i;.;`.OVER:THE�COUN�ER�,PERMI7TING> ,(capy�ofcontract�required)�'� �``�'' �' _ '
<br /> _';Reroof§if stiingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage) _
<br /> Driveways-N It over Counter if on public roadways..needs ROW t '
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