|
„ � � 813-780-002ti Cify of Zepliyihllis Permit Application Fax-813-780-0021
<br />� ' Bulidfng Depedment �
<br /> . .. .. . ,..
<br /> Oate liecelved - -
<br /> ., .........,.:...._. ...... ,....,.._.... Phone�orit�et(or Permlllin ...._.......... .._.. .. - ..._,_.,...._.,....._,..,..
<br /> �� Owne�'s Nema. �Q�....w-1.r'I . . . Owner Phone Numtiei -. � '_',�. a... .
<br /> ..... ... . ......... .... .. ..... ... . ...�._ ._ ',
<br /> :. .. .. .... ..... .. .
<br /> , . ..
<br /> Owner'u Aaitre'ss.�gS3 .� .';�`... -4- � lS OPinei i�Hdne Nutnb�r �.�.3-.�ip�.,'.Q.���.� �
<br /> _ ,... .... ..._ �.......: .....
<br /> .,. ,. .
<br /> IFae 9lmple Tllleholder Neme �: ,..,�. .....:...... ... ... .� bv�in§r pKone Numb�r �- �
<br /> ' Fae Slmple 7111eholder Address . .. ... . . . .... . . . ..... ... ._, ...........,... ....._.......,.__._.....,.._._. . ..._ . ...
<br /> ... , ..._._..,..._...... .. .. .:.. .. .�,. ._
<br /> ,. ,
<br /> aoaAoo�Ess .�_ .. o'�--_ . . � �t�.I.15��-It�r�`�_3 . ._. ....__ �or� ��
<br /> _ ,.. :.._.....:.. :....... �....:.. _.. _..�.._... ._..:... ._
<br /> .. . . ._. _ .
<br /> .........
<br /> (`� . ....
<br /> . ..
<br /> sueaiv�§iaN l.. . .. . . .. .. .. ...... . . .� PARCELlD� �_r -02�0��1-G�50-c?L?4�-- �b(�D... . . . .
<br /> . - .. .� . . . .. ... . . . .. . .. {OHlAtNE4 FROM PROpEftiY TA7E NQYtCE} �
<br /> WpRK PROp4SED e NEYJ¢oNSTR B ADDIAI.T �..�, 51GN ��,' Q DEMOLISH
<br /> INSTAL4 REpAIR
<br /> :.
<br /> PRK?POSED tI&E . . . .
<br /> ' Q SFR [� CoMM . ..
<br /> _ OTHER :e_. .
<br /> .... _.. ._�. _. ..
<br /> . .. .� ._.
<br /> 7YPE OF CpNBTRUCTION � Q BLOCK "'. FRAM� - . :�
<br /> _._.
<br /> ....Q � STEEL � ��� .- .�I
<br /> . . ._... . .. . _.-... . . . .. ._...� .. _ . ..
<br /> . . .
<br /> ... .
<br /> . ..... .. .[ t f . ..
<br /> DESGFtIPT10N OF WORK . . .. , ... . TFl.�1RI.1Jd.t'�rjZ►... .C�J . c'S
<br /> i :. ............... .. ..... "':::._.. . .. . . ' . .,..
<br /> I ;... . .. . ,
<br /> ......._....:... ....
<br /> � BllIL4�lNd 81Z� � ..- f_ ........� SG1 FQO'TACiB� liE1GHT �______�
<br /> � . , s.._.. F AL CO , . _
<br /> r �1”` . - : ': -.:' _ ::".":';':�.- ,'..._-:: .:.:t'r'r'�'7'^e'T`e''..,. ..'''.: ,"_ ':'" '. "_" :' _ 1'�rr-
<br /> _..._.,. ...� ..
<br /> _.._.��i.,_v.,..`�. .
<br /> QBUILDINO $ VALUATIt]N O TOl NS7RUGTI(7N
<br /> . . ..
<br /> ��
<br /> _. .:...: .. .... ._.
<br /> - _._
<br /> _��EL£CTRiCAL ($ `-� AMP SERVICE r'.�.. pROGRE§S ENERt3Y Q W.kt.E.C.
<br /> �r-•._::._..._ .
<br /> QPi.UMBING �� �
<br /> ,� j �r� �3
<br /> �MECHANICAL $" ' "`�' " 0{�'" VAL4JATIpN OP MECHANiGAl.INSTAtlATtON �� �
<br /> +,_. ,.
<br /> - , .,._...... . .. ..... -
<br /> i ��CiA9 Q ROOFINO Q SPECIALTY �� 07HER ,i.'
<br /> � . , .. . � __ _., 7L�y
<br /> FINIBFIED F400R EI.�VATIONS F�tt(?D Zt3,ftE AttEA QY�S NO
<br /> .1..{-{-4.1-1�{-I.:i.1=1-1"�-1�:.-^C-C-'':.�r:-1-r1:.1:N=W1=1={�i�4:{:{-L:4.1.+4�.:1_W::'......-. :-.-�":-L:a�'..:'.-:_p::-4-1=L=4:i.:F.L��S=:��:'�
<br /> _�__.._.....,.... .. .. _ ,.... .
<br /> ._._ ,
<br /> .. .
<br /> _�_. . . .
<br /> _.
<br /> BUtLOER � COMPANY �. ... ...�...._._..' � . . . .�
<br /> 514NATl1ftE _ ..� d�aisTEa�a �.Y.Y.N.,. Fescuaa�n .Y_LN..
<br /> ... ,_: . . . ...., . .._..: . __
<br /> ..__:...,... _
<br /> ; . .. _.
<br /> � Addreas " [��
<br /> ... ,.. _._
<br /> � .,� . -.. . .. . . ................. .. Lieense# t
<br /> . .... .. ....... . .. . .::' ' :.._..'...... _ - -
<br /> .._ ..,.. .. .... .
<br /> . .. .... �
<br /> ., ..... .
<br /> , , . .. .. _ .. . ; .. . ": . .
<br /> � EI.ECTRIGIAN `GOMPANY
<br /> • ,, . _...... . , . _ ..... , �.
<br /> 8IGNATIIRE _ 1tEt313TER�D� Y l.N... FE�COFiRER- Y I N � �
<br /> i .... :. .. .. . ........ ....... � ..'._... .. ' - ' '
<br /> , .. .. . . . ... . .. ..., . ' :. '.' ": . . . . -
<br /> .. ..... . . . .
<br /> �� Addresa , . . ... Uben'se#
<br /> .. . . . ..
<br /> � _. ..- �. .. ....... ... ._ ,....... .. .. . . _..
<br /> .. . .. ....
<br /> .... . -
<br /> i . . .... ... ..
<br /> ' PLUMBEtt ' COMPANY � .�',�....... ............._._...,_. .. . ,�y.�
<br /> �I SIONATURE , . . . . . . .. . ...........'REOIBiER�p ... .Y/ N.�:���� FEECURREA .. ..Y/N.. � �i
<br /> ... . . . . . .. . . . . .
<br /> � . . . . . ... . .. . ... . . , r' . ' . . ... , ,
<br /> .. ... .. . ... .. .
<br /> Address .... _.. . . .... . . .. .. . �. . . License# 1 - ...... .. . .�
<br /> .. . . .. .. . . . .. ..:. ....... ... . . . _ _ :. ... . _ .
<br /> . . . . . . . . _
<br /> MEGHANIGAI � COMF?AN`t J!'1� .�!`tr�� Q�� #`"IT��`F�'..... .
<br /> ( $I(3NATURE _ .; . �, .,,_-......... . . . . . ..... RE6ISTEREO � _Y./.N.`� FE�CURREt� ' :..Y.JFI.� �
<br /> I .....
<br /> . . . .. .,. ........ .,. .._..,..._-.
<br /> ..v"'. .-.... . ., ... .. .
<br /> ._ ....
<br /> I . . .t � ��C� ! ,/pr/
<br /> �f7� I /1�,, p :.:
<br /> ' Address 0 CxJ,p:�,� Z.._ ,. , . ..�.µ.s. :. . 1 . . Llcensef� C./7("f0/J�.�7.�t�S �
<br /> .
<br /> UTHER COMPANY .............. . .
<br /> ,.. _ . ... ..... .._ .....�
<br /> . SIONATUR� ... ._. .„: ... .. . .... ....... ...«..,... �REDISTERED Y.'/ N'.- ��ECURkEA Y/N�- � �
<br /> . . . .:.... .. .. .. . .. . ...... .... . . .. , . . .. � _
<br /> . ..... .._ ..... . .. _,...
<br /> Address .. ._ , Llcen'se# L _ _ � �i
<br /> ' iiiriiiiii � iiilii � ii � r"il � � ii,� tii � r�iiii � � l � i � i � � til � ii.iM � � � ii � i"i � iii i
<br /> , RESIUEN'f1AL Aitach(2}f'tok Plans;(2)sets ot Buiidltig Plaits;({)set o(Ettergy FoimS;F2-Q-W Peris�tt fot neW con'sttuciloir,
<br /> Minfinam ten(10j worktng d&ys'efte.r'sutimiiteffiate. Requtied onsite,Constructlon Piens,'Sfortnwater plens w/.Sflt Fence insiailed;
<br /> Sanllery Facllllles.&1 dumpsler,Slle Nlork.Permll tor subdlvfslonsllerge proJecls
<br /> ' COMMERCIAL Allach(2)complele sets of 0ullding Plans plus e LIt6 Setely Pege;{t)9e!of Energy Forms.R-D-W Peimlt foi new consituctlon.
<br /> Mtnimum ten(10}wdrktrig days after subm}tkaE dale. Requtted onslle,Gons�rucklori Plaris,Stom�wster Plens w(Si1t Fence lristal�ed,
<br /> Sa�flery.Faclflttes&i d'ump@ler.Stte Wbrk Permtl foretl new praJecls.AII comrtierctel requlreinents niust mesl campffehce
<br /> ' � SIGN PERMIT Allach(2)sels ot+�nglneered Plaps:
<br /> ""'PROPERTY 9URVEY requ4red to'r at{NEW conStiucllon:
<br /> ' , . ...:....-.. . . ._._...-...... . .
<br /> :i-4�ir�i�l�iri�tih{=i�W�i-i�S.I�i=i�Mi-i-t-t�i:.a'. ......-� .. .�+„�• s-i�..-+-.-.-.-.-.-.- . . ......-...._...: �;, �
<br /> , . Dtrectlohe: '
<br /> ;I FIII oul eppllc9llon eompletely.
<br /> ( _ Owner S Contractoc slgn 6ack ot appllcatfan,aotsdied
<br /> It aver�2540;a Not#oe ot.Gummencement Ia requtred; {AtC upgtad+�'s aveP 57600}
<br /> � " Agenl(for lhe conlreclar)or Powar ot Allorney(for Ihe owner)would be eomeone wllh noterized leller Irpm owner aulhodzing seme '
<br /> I � '
<br /> OVEfl THE COUNTER P�RMITTINO (copy ot cantiact requlred)
<br /> Reroots ti shtngtea Sewers 3ecvtce t)pgradea AIC. fie�ces{PtoUSurveytFaotagej -
<br /> i , II prlveweys-Not over Counlar If on publlc roadweys..needs ROW '
<br /> �� , `
<br /> Y •
<br /> il I � .
<br /> ' " ". r z. .+ . ���.
<br /> �
<br />
|