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81�s-�s -oazo " P rmi licatian Fax-813-780-0021 <br /> . .� G�ty of Z�phyrk�ills e t App <br /> Butlding Depsrtmertt <br /> Dats Rsce�'ed phone Corrtact far Permitting �3 �.- — ���� <br /> ._.�..�,.,¢.�_.���..i...�,. - - - _r-�_�..�-�. i <br /> Owner's M�me ` Owrner Phor�e�1um6er ��"' t� '-�4� � <br /> Owner's A�dress � � ,.�L. Owner Phon�P4umber � � <br /> Pee Sfmple Titleholder Name � � Quvner Phone fdumber �� � <br /> Fee Simgle,7itleholder Address <br /> J08 E1DD�tESS � L f1� LAT# �„� <br /> sUBDIVISf�N � � PARCEL 1Di� <br /> (OBTAINED FRQM PROPERTY TAM NO7lCB? <br /> WOFt{C PR �POSED � NEW CONSTR� ADD/AL.T �,� SIGN [� [� DEMOLISH <br /> INSTALL REPAIR <br /> PROP�SEt�USE [� SFR Q COMM � OTHER <br /> TYPE OF CI� PISTRUCTION � BLOCK Q FRAME � STEE� [� <br /> DESCRIPTI IV OF WORK /lrt �-� <br /> BUILDING ifZE � � SQ FOQTAGE � HEIGMT �_,� <br /> � <br /> 0�I «����' �� �� VAWATION OF TQTAL C0�ISTRUCTIOM <br /> QE�ECTRICAL $ AMP SERVICE � PRO�RESS ENERGY Q W.R.E.C. <br /> [�P�UMBING $ l V V� i� <br /> Q CHANtCAI. �� VALUATION OF MECHAhliGAL ENSTALlAT10N <br /> � �� , <br /> �G S � R{}OF1ttfG � SPECIAt,TY �� Qi'HEFt <br /> FINISHED LOOR ELEVATIONS FLOOD ZONE AREA QYES iV0 �`~f-�" <br /> � � <br /> BUtt,DEi2 - - � CQMd��tY �.r2 1+'�-� t"���t�t.+� ��Q.� <br /> SI�xfUATUR „ REGISTEREt7 Y/ N FEE CURREP Y 1 <br /> Addre � 'rJ T� (� i � 3 SA�'2,._. License# �(.,C°�..}. ��„�� g� <br /> EL�CTRICt1� COMPAI+�4Y <br /> SICaIdATURIE�, REGISTERED Y/ N FEE CURRE� Y I IV <br /> Add s Llcense# � � <br /> PLllMBER C01�IPAtdY <br /> SIGiVAYUR R�c�isre�o Y/ N FEE CURRE� Y/N <br /> Addre�s liaense# � . , � <br /> 11l��CHA�IC�1. COMP,4�IY <br /> SIC�ATUR'� REGISTEREp Y/ PJ FEE CURREP Y/N <br /> AC1d[8S� �iCL'ti38# �Y � <br /> OTHE� � � COtVIPAtdY <br /> � Slt#NA'NRE � � REGisTERED Y 1 N FEE CUt2REM1 Y!N <br /> Atldre� Llcersse# �� � <br /> tY11p �� i11S11i1tfMIQ1lPial� P6 � 1IP1 { 1@Itp � MDltlt1t11181ttCii11 / tililA � <br /> RESIDEtdTlbL Attach(2)Plot Plans;{2}sets of Building Plans;(1}set of Energy Forms;R-Q-W Pennit for new construetian, <br /> ' TV�lnimurn ten{10}wa�r�g days after submittai date. Requtred onslte,Constructlon Ptans,Starrnwater F�lans w/Silt Fenc�tnstailed, <br /> Sanitary Faalities&1 dumpster;Site Wark Perrnit for subditisions/large projects <br /> COMMERC!'AL Attach(2�complete sets of Bullding Plans glus a Life Safety Page;{1)sei of Energy Forms.R-C1-W Permit for new construction. J <br /> Minimum ten{14}working days after submi#tai date. Fteguired onsite,Cans#ruoUon Plans,Stocmwater Ptarts w!Sitt Fence tnstatied, I <br /> Sanitary Facilities&1 dumpster.Site Wark Permit for all new proJects.All commercial requirements must meet compliance <br /> S(GW PERM�T Atfach{2}sets nf Engineered Plans. <br /> `*'*PROPERTY SURVEY required for at!MEW construction. <br /> D9r�ct9ons: (i <br /> F►1!auf�pplicatian comptetely. <br /> Owner Contractor sign back of applicatfon,notartzed <br /> If over 2500,a Notice of Commenaement is requ4red. {AtC apgr�des over$7500} <br /> ** Agent(or the contractor)or Pawer of Attomey(for the owner)wauid be someone with notarized letter from owner authorizing same <br /> OVER THE QUNTER PERM17'CIRlG (copy of contrac!required) , <br /> Re�crofs ifsh�ngtes Sewers Ssnaice Upgrades AtC �ences(P#of/SunreyiFootage) <br /> Rrivew ys-f�ot over Counter iF on public roadways..nseds ROW <br />