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<br /> �,81.�78(t�--0020 City of Zephyrhills Permit Application Fax 813-780•002�
<br /> Buitd€ng Depa�trnen#
<br /> Date Recetved -.� r� 1 . , t?hane�Contact for Fermittin �}�� �,� ! — ����
<br /> Qwner's Name � �('d f� t� � '� �t�Sl ' Ownar Phone Number ,�"" � t O' �Z �tj
<br /> Owner"s Address ;�,J�o� Z�f �'�C.- Ze � f �`�� 33� Owner Phane Number �� �
<br /> Fee Simple 7lkleholder Nama Owner Phane Number � �
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<br /> Fee Simple Tltleholder Address
<br /> JOB ADDRESS ��� �J'� C �� Z�, �Y`� 1S ��- ��5��Z LOT# ��
<br /> SUBDIVISION � .� � PARCEL ID# -
<br /> � tOBTAINED FROM PROPERTY.TAK NOTICE)
<br /> WOR#t PROROSED ;NE1N CONSTtt ADDtA1.T C� SIGN' 'Q �[� DEMOI.ISH
<br /> , INSTALI, REPAIR '
<br /> PRQPQSEQ=tlSE . Q $FR [� GOMM � C?THER
<br /> TYPE OF CONSTRUCTION' Q� BLOCK " C] FRAME �� STEEI. Q
<br /> DESCitIPTION OF WORK•' l�V�G � l �� O� Z
<br /> BUiLD1N1G`StZE" �� �'SQ�FOOTAGE�w� .HEiGHT�C�_---_�
<br /> QBUt�DlNG � � VALUATION:t"�F TOTAL CONSTRUCTION M
<br /> QELECTRICAt. �' �} AMP SERVICE Q PRO�RESS EttitERGY Q W.R.E.C.
<br /> �
<br /> �PLUMB(NG $ ��
<br /> �� �"
<br /> QMECHANICAi� $ . VA�UATION t:1F=MECFfAN1�Al.tNSTA1.LATIdN `��� �
<br /> oc�. ao_ , ..
<br /> QGAS Q RQOFlNG .[� SPEGIA�7Y � OTHER
<br /> FINISHED FLOOR ELEVATIONS �„_� FI.00D ZONE AREA [�YES. NO
<br /> BEJt�DER COMPAt�tY�• � ` .
<br /> SIGNATURE REGISTERED Y/ N �ee curtrten � Y/N
<br /> Addres$ - • . •� � Cicense# � �
<br /> ELECTRICIANs : - �'COMPANY� _ ., .. .- . ,. .
<br /> SIGNATURE � REGISTERED Y/ N FEE CURREN` �' � Y/�N . '
<br /> ,..,, ,. , � . .,, ' ' �
<br /> Arddrsss ` � - � ., , ,� Ucense:#,� � �
<br /> PLUNIBER ` COMPANY � . { - ... �
<br /> SIGNATURE , REGISTERED Y./,-N�� -; �FEE CURREK �< �. Y�/N �:�
<br /> Address " .License,.# ��� . , " �.
<br /> MECHA!@lCAI: � COMPAFlY V("t1U�S� .�C.!�t�ltCG�, .`
<br /> SIGNATURE� ' ' REGISTERED Y,/-N , FEE CURRE�> Y/rN
<br /> Address'' '-�I'2=- !V•i/�' ��� S t,`!�t'�' � (11i� Flr .License# � { , _ �
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<br /> OTFiER � � • - ' `:GOMPANY
<br /> SIGN�►TURE �-- '' '� " ` ' � REGISTERED?` Y/ N .. FEE CURRE� Y/N „
<br /> Address, 1:a � ~ , " • , . � ` 1:Iceiise# � � �.
<br /> � .;..,.:x ... .:.: ... .... ., ...,.,_,:_,,, . ., ,_. , ... . :. �
<br /> RE310ENTIAI:.t� = :At#ach�(2)P•_tot P.,laiis;�(2}set��oi=Bullding�t?Can"s;'(1}`sef af Eriargy�Fosms;`R=O={tV Peimif hir new ccinstructian, .
<br /> , _ �.y„ . . .
<br /> Minimum�ten�(�1.0);working;days°,after;subrrilNal'date::Requlred onsite,•_Can'structi6n-Plans;`Stormwater'Plans w/Stlt Fence installed,
<br /> '-.'.��::_;r.,.,.,.. . . - _, , .,
<br /> � Santtary FacillUes&;1;dumpstar•�Site�Wa►lePermit,#or subdivislons/large�projects,:, -: ' � �`_
<br /> C4M{I�ERCIAI.. Aftach{3)-comptete sets of Buitiling Plans plus a Ctfe Safety Page;'{1}set af Energy Fctms.R-O W Petm�t fof neuv sonstructldn.�
<br /> Minimum ten(10)working days afker submittal date. Requlred onsite,Construc8on Plans,Stormwater Plans w/Silt Fence fnstalled,
<br /> Sanitary Fadlitles&1 dumpster.Stte Work Permlt fior a41 new,proJects..All commercial requframents_must meei camplience
<br /> S16N PERMIT Attach{2)sets iif�Enginee.r,ed-Plans::� :�._ .. _
<br /> ""*PROPERIY SURVEY requireri for_all NEW const[ucUon.. - .
<br /> D3rectlons: -• <::�,� . ' .
<br /> FIII out applfcatlon completely.
<br /> t}wner&Contractor slgn bacic af appilcaEtlon.notarized
<br /> it over E2500,a Notice of Commencernent is required. (NC upgradss over St500)
<br /> i .;.:y„r•: : _ .
<br /> " Agent(for the contractor)�or'Power of Attomey'(fcir Uie.owner)would be�someone with natarized letter from owner authodzin�same
<br /> dVER THE CQUNTER PERMFTTiNG�'-- (Front of'�Apptication-Only}-- � :; ' "
<br /> Reroofs if shingles Sewers �� Service Upgrades;NC �Fences(f?IodSurvey/Footage)
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<br /> Drivewaya-Not over Counter if'on,pubiic roadways`..iieeds.ROV1/';,- ;
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