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� e�3aso-oozo City of Zephyrhills Permit Application Fax-813-780-0021
<br /> _ »- ' ' �• • Building Department
<br /> , Date Received � 2Cp l� phone Contact�for Permltting —
<br /> � Owne�'s Name �� �� Owner Phone Number
<br /> OwnePs Address v�� � e �"(�-�r w �i'C 3� Owner Phone Number
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<br /> ; Fee Simple Titleholder fdame Owner Phone Number
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<br /> Fee Simple Titleholder Address
<br /> � JOB ADDRESS 3�y3 7 ��1� �{ � l2c'l(� ��� 33� � LOT# �
<br /> ' SUBDIVISION st o n !�r F PARCEL ID#
<br /> (OBTAINED FROM PROPERTY TAX NOTICE)
<br /> WORK PROPOSED. �` � NSTALLSTR e REPAIR � SIGN Q Q DEMOLISH
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<br /> PROP.OSED USE Q ' SFR Q COMM 0 OTHER :
<br /> TYPE'OF CONSTRUCTION Q BLOCK • Q FRAME � STEEL Q
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<br /> DESCRIPTION"OF WORK � 7�'-r✓^ d r �E'r��� �`L�-� �� (Z � S
<br /> BUILDING SIZE SQ FOOTAGE ( r��� HEIGHT •.
<br /> OBUILDING $ � ( � o�v VALUATION'OF TOTAL CONSTRIJCTION
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<br /> � QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
<br /> � QPLUMBING $
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<br /> � QMECHANICAL $ VALUATIOIV OF MECHANICAL INSTALLATION
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<br /> j QGAS Q ROOFING � SPECIALTY 0 OTHER
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<br /> � FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
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<br /> i -BUILDER COMPANY
<br /> � SIGNATURE REGISTERED Y�/ N FEE CURRE� 1(1 N
<br /> Address �License#
<br /> ELECTRICIAN . COMPANY
<br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address License# � � �
<br /> �iY.�%
<br /> PtUMBER,,, COMPANY- �
<br /> SIGNA'TURE REGISTERED Y-/ N� FEE CURRE� ` Y/N
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<br /> � Address Licerise#'
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<br /> � MECHi4NICAC � COMPANY
<br /> j ' 'SIGNATURE' REGISTERED Y/ N FEE CURRE� Y/N .
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<br /> � Add�ess�' � � License.#
<br /> ,, s�,���� ,.., ��.� ��{rl"�.(r( \a'L
<br /> ;;•OTHER°;. `:-- � �/� ' C,OMPANY Z/q C� �.� �
<br /> �`'SIGNATURE�$��= .^ N "� - � REGISTERED . Y/.N . F CURREK Y/N
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<br /> " Address� , � •,�.,c�G..-: .` a.�c c; �.,3�3 G.<c� = License# C��C ��a--�?p�—
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<br /> j;_°;RESIDENTIAL?;;: ':Attach`(2)sPlot;P.lan's;'(2)�sefs�ofi:Building=Plans;(1�)°sef of�Ene�gy`Fomis;R;O-W Perm.it,for new.construction,��
<br /> � �=��:.,�:�:;>;.-�Minimum„ten,(;1Q)yworking,clays'afte�sutimittal:date.`Requireii'onsite;'ConstriiCtion Plans;Stormvirater Plans w/Silt Fence installed,
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<br /> �� Sanita.ry.;Facilities,&��.r1zdumpster;,,S,ite:Wor,kFermit-fonsubdi4isiops/large:projects
<br /> `<�`..C:OMMERCIAL Attach'"2'`com` lete'sets'of'Buildin Plaris lus a Life Safe Pa e; 1 sefiof Ene Forms.R-O-W Permiti for new construction.
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<br /> " . Minlmum ten(10)working days efter submittal date. Required onsite,ConsUuctlon Plans,Stormwater Plans w/Silt Fence installed,
<br /> =`` Santtary FacillBes&1 dumpster.Site Work Permit fo��all-new p�ojects.All commercial requirements must meet compliance �I
<br /> �r=;'SIGN:PERMIT �AtNacFi(2)sets::of;Engineered�Flans.;�° : �. �
<br /> i :;';<,�� "'""PROPERTY SURUEY required foc aII,NEW.construction: ,
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<br /> ; �'�Df�e'ctions: :�z=�<<�_.� ,. .. �I
<br /> � :: "''� Ffll-:out application completely. �
<br /> ! , 'O.wner&ConVactor sign�liack of application,notarized
<br /> �If,over$2500;a Notice�.of:Commencement ts required. (AlC upgrades over$7500) _ , ;,
<br /> ,Y'°" i4gent'(for4tie�co`nt�actor)`orPowerof'Attomey(foYttie ovmer)vuould'tie someone with notarized letter from owner authorizing same '
<br /> ' ��;:OVER�.THE COUNTER�PERMI'I'T,ING._ (copy-of-contract-.required)��' '' -� � �
<br /> ; ;:`Reroofsifsliingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage)
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<br /> Driveways-Not over Counter if on public roatlways..need§ROW
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