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<br /> 813�780-0020 City of Zephyrhills Permit Application Fax 813-780-0021
<br /> Bullding Departrnent
<br /> Date Receive � i '
<br /> �u �� :��:Phone�Contact forPermlttin -
<br /> Owner'a Namle .��A �S�• L�S Owner Phone Number I - - �7 '
<br /> Owner's Address �• o� l.�� � ,�U �- Owner Phone Number
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<br /> Fee Simple TlileholderName � Owner Phone Number
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<br /> Fee Simple Titleholde[�.Addresa -
<br /> JOB ADDRES3 C� d l � ; � _ ^(, 33 OT# �
<br /> SUBDIVI310NI , G L�rl� V I LLA�t°� PARCEL ID# ` - - •
<br /> I • - , (OBTAINEDF.ROM.PROPERTY,TIUC•HOTICE)
<br /> WORK PROP i SED *�NEW CONSTR . ADD/ALl' C]� SIGN' "Q� � Q •DEMOLISH
<br /> . INSTALL 8 ,.. REPAIR
<br /> PROPOSED�UI$E , � �] SFR. a. COMM , � Q •OTHER _ '
<br /> TYPE OF CONSTRUCTION"•� 'Q'� `��'BLOCK r []- FRAME :Q STEEL `Q
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<br /> DESCRIPTION OF WORK/` � ` �� ' � ��
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<br /> BUILDING`SIZI�'� � " �`�Q'FOOTAGE�]: , NEI,GHT�.
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<br /> �BUILDING $C�'(�n O` O� VALUA710N�OF'TOTALCONSTRUCTI�N ' �
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<br /> QELECTRICAC $ ' AMP SERVICE. Q '�PROGRESS ENERGY Q W: ,.E:C
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<br /> OPLUMBING�� $ � ' `�� r
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<br /> QMECIHi4NICAL' . $- '' ' �= VALUATIONOF:MECHANICAGINSTALLATION � ( �
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<br /> �cAs [� ROOFING Q, ;, SPEGIAL;7Y;.0.•,- Ol'HER�, ,. , :
<br /> FIfVISHED FLOOR ELEVATIONS FLOOD ZONE AREA ,QYES. NO � �� , �"��
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<br /> � BUILDER I . � '�,� COMPAMf�` - `��IL(i����/" '`
<br /> SIGNATURE /• REGISTERED Y/ N , "='�FEE CURRE�.� ° Y=/'N= � �
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<br /> Address �: ;�: _. • � :�� <.; , _ �Llcense�.#'` ,st r � _.
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<br /> ELECTRICI�iN., .. 4jCOMPANY`,'� rak '1'..'.t't,..y,tr,� .,.`r ,Y... ' ".. . .,' , `
<br /> SIGNATURE � � REGISTERED Y/ N FEE:GURREK';� �'�`'-==Y/-:N> .
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<br /> Addre�as` , �' - , , , . - -• Licensei#�;� _ '.
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<br /> PLUMBER ' � - --�C.OMPANY � �<: �., .: . s� ,;< +.;:�� �. �:,� :n. -
<br /> SIGNATUREJ` *�° " �}' -:REGIST.ERED ' �Y/ N;� �;Cuw��;� -nY�/N,.- . -
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<br /> a►ddress • .'` . �. ' Licenset#' � . - � . ,-
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<br /> IIAECHANICAIS`' ' . . , - - , � '� � COM�ANY - , .
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<br /> SIGNATURE� � - ` • REGISTERED . Y„%,N ''�E CurtrtE�,. 'Y/�N�
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<br /> Address:; - , M, .< • Ucense#� , ..
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<br /> O'iHER �}=: .,�.. : .L• _ ,. ." ,COMPAPIY _;���,,.,. : : . _
<br /> SIGNATURE�: _ - -, �, , _ <z� , . , , w:�:� �9,;:<, .. ,
<br /> • '' ' � ��REGISTERED 'Y/ N;.�: ;�E°Cu���J Y7 N.
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<br /> Address ' ��,�fi,.� ,�.r..'r'y ,..,2���+�.�°: -. _ ..- _ . K_, ,. ,,.-� ' . . ' �License#�A. ., •,. , --
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<br /> -�RESIDEN7IAL��; `;Attacli;(2);Plofs_Plans;:(2)sets::of'8uil'tling�.P..'lari`s;'(1)set'of�En'ergy;Forms;�R-O=W�Perrnit�fo�-nevi►°co'nstruction,
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<br /> :�,,,�Minimum�ten,(•;I,O)�wo,riiin`g;de�ys;;after,:"submlt�al:tlate:�.;Requlred ohsite;.'ConstiucBon:Plans;�Stortnwate�=Flan`s w%Silt Fence installed,
<br /> , ..� Sari(fary'FaclllUes�&;i1-;du;.r,r�pste,r,��Sita°Worlr;Permit.forsutiiiivislons/Iarge�proJects��'`' �r�r: `"�;:": . _ ,_.' - '
<br /> COMM�itCIAL Attech(3)�compt'ete'sets�of'Building Plans'plu§a�Life Safefy`Page;(1)set of Energy Forms.R 0-W Permttfor neuv.canstruction. �: -
<br /> Minimum ten(10)working days after submlttal date. Required onsite,Constructlon Plans,Stortnwrater Plans w/Sflt Fence installed,
<br /> , Sanitary Facilitlas&1 dumpster.Site Work Permit for all nauv;projects:::All commerclal.requiLements_must meet compllance ' � �
<br /> .. SIGN PERMIT AttacFi"(2)'sets of`Engineer.ed;Plans:��,:{>�;=_ . . .•:;..�. - - - -- ,.- � ' � � . .
<br /> ""PROPERTY SURVEY reguired for all NEW_constructlon.� __ - �
<br /> Dir"ections: , :�,�`�;'•,,�' ;._ •- �
<br /> FIII out applt II tlon wmpletely. ., '
<br /> Owner 8 Contractor sign back of appllcaUon,notarized
<br /> If over�,ZSOO,,a,No41ce of Cortomencement is requl��d. (AIC upgredes over 37500) , �
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<br /> " Agent(for the oontracfo�)�or Powe�of Atfotney(for the o'vuner)would be someone with notarized letter from owner au_thorizing-same•'-•~-'-
<br /> OVER-THE:COUNTER�PERMIYTINGu�±��:,-( ro t,of�� Iicatlon•Onl -+ `•
<br /> F �!. !°►PP Y)�'�:-?� , �-<._ ,. . ;.,,� ��; . .
<br /> Reraofs If shinglesII Sewers Servioe Upgrades,;A%C; Fencas(Plot/Survey/Footage) ' ` ." ,:' ,,,, ,.� ., -_
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<br /> Drlvewaya-Ni t over Counter if on putilic roadways:�rteeds ROIN:i}� . s , z .•-^�^^ `
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