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<br /> a��-�saoozo City of Zephyrhills Permit Application Fax 813-780-0021
<br /> . Buiiding Departrnent
<br /> Date Received �-r��' , :;: Phone'�Contact',for Permlttin
<br /> Ownee's Name � G+ Owner Phone Number • j •
<br /> Owner's�ddress �D�2,3. ' • . 77�".�Cl�' �y71 r
<br /> OwnerPhone.Number
<br /> Fee Sistiple TitleFiolder:.Name - r � Owner Phone Number � �
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<br /> Fee Simple Tldeholder,Address ,
<br /> JOB ADDRESS ((���� ^ �(,fJ� � �e j ,� 3�S � LOT# / �
<br />' 3UBDIVISIOPI PARCEL ID� � ., ..
<br /> � • , � . . (OBTAINEDFROM,PROPERTY,TAX�NOTICE)
<br /> WORK PROPOSED = NEW CONSTR' ADD/ALT [�� SIGN' '[� � Q DEMOLISH
<br /> ,_, :B. INSTALL � REPAIR _
<br /> PROPOSED..USE , , � SFR [� COMM: �. Q- " •07HER' _'" '
<br /> TYPE OF CONSTRUCTION"�µ �� '"BLOCK " '� FRAME Q STEEL 'Q
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<br /> Df�SCi31P110N OF WORK' - y a I S F � '
<br /> BUILDI _ � �`SQ�FOOTAGE,' � : , ,HEIGHT� �
<br /> QBUILDING $����/��� ,, VALUATION�OF'�TOl'AL CONSTRUCTION �. �
<br /> QELECTRICAL $ " AMP SERVICE. � �] - '�PROGRESS ENERGY [] W:R.E:C.
<br /> QPLUMBING � $ ` ' -
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<br /> OMECHANICAL" $ b�ILUAl'ION OF�MECHANIC�►L IN$7'AL'LATION: •� L �
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<br /> QGAS � ROOFING .Q; ;, SPEGIAL'TaY,:�] •,__„OTJiER�, .,• , � - . �
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<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA ,[�Y�S. ,NO
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<br /> I �111LDER '- OMPP�AIY" . - - - '
<br /> SIGNATURE �' ' ,l ��EGISTERED Y/ N -'�>FEE Cu��.` " F"Y/`N= ' ' "
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<br /> Address �; ,;, � , -+; , �Ll�nsei#�` „` . - ,
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<br /> ELECTRICIAPI:, . . , � ;,;COMPAMY- ��`� a s:.••� ' = - , ,� •,
<br />� �ICi�lAT�1R�-� � REC!FTERED Y/-N ^ ' , --- — -— -— - -
<br /> FEE�rIJRREl��-t ;:Y/_N-
<br />' Addre�'- ., - .. . .. .. - ' � , - . _ ; . , azr.:,�, : , . :. .> •.. , , . .. � r
<br /> , • , . � s;:�,�,;License�#�. -
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<br /> PLUMBER .. . „ '` ,C.OMP,..AN,Y, . •Y„r .��:�; �� . .
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<br /> SIGNATURE� ' - �REGIBT.ERED- s. ;:Y,/,N:: ..•F��cuwzen.� - Y.:-:/N,;. <
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<br /> Address � ' ' . � .-. ;l, . : LI'cen.se�#j - � �' . - - ,
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<br /> MECHANICAl. , .. , .. , , . , ; ;; . , , .. 4, T�.� „ .. � - • -
<br /> COMPANY . .._-....., .
<br /> SIGNATURE: . -=f�.. ..,. � . ,. , .. ' ,: - . �,,: + • ,_
<br /> '' REGISTERED . Y„/,N FEE CURRE�,.. �Y./:PI'
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<br /> OTHER `�� , . 4 . ..: . ... . . ... '• . ;COMPANY � ,t , , � � �
<br /> SIGNATURE< _:. - -_ �;� r.' , .,•� .. -. , _ , -. . .�., 3�.��, , _ , ._ .
<br /> �REGISTERED'� �Y/�I�}. ��E'Cu��• Y7 N
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<br /> �df�$8 (�,7-:,;i,�,';rM1�'.. :`v ;F.",a.�:-�'i":.i" ..r.. �F.''�:,t:.. - :'x ?. , x.s, , ' , , ' ' ' ., 'f y. � . -. .
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<br /> RESIDEN'i1A_L'•�;:;:`,:;AttacFi.('2);PlottPlaris;'(2.)se�:of�BuildtrigfPlans;`(.!)set�oftEnergy=Fo"rim's;'R=O=WuPerm�ltfdr�new�construqdon, , . � •
<br /> -r Y::�,:Minimum�ten„(10)�worf4ing�da�y,s„after�submltfaF:date':',�Requlreii on'slte;:Consfnictlon-'Plans;�Sfortiiwater'Rlans w%Sllt Fence instelleii, �
<br /> �Sanifary FadliBes;&�1,;dutr,�pste,r,rSite-Work;P:,ertnifto��subdlyislons/le�ge�pro�ects�',�•,��,�i,,,�..'.: . --
<br /> COMMEFLCIAL Attach(3);�oomplete'sets'of'Bu1ltling`Plans`plus a�Ufe Safety Page;(1)set of Energy Forms.R-0-lfV`Permit for neW'oonsUuction.- � � �
<br /> Minimum ten(10)worictng days after sutimittal date: Requlred onsite,Construcdon Plans,Stortnwater Plans w/Sflt Fence installed,
<br /> - Sanitary Faciittl�s81 dumpster.Site Work Pemnit for all nainr<'proJect's.:All commerGal�ul�rrients_must�meet c�mpllance.��� �
<br /> SIGN PERAAiT AttacFi'(2)"sefs of"Engjnee,red;Pla�s:�;:�»:^��;� .. -,•:� ' . � , . �
<br /> �. . ,., .,;,,,._
<br /> ____ __ _ ""PROPERTY SURVEY required for.all NEW constiucUon.. _ _ ' � � • �
<br /> —_—`' �__ v. .�.. .�..._...�. -..f .
<br /> Dlrectlons: ..,.,-��,,,.,,:- .� _ . _ _ -- -- _ ..- ---=- - __ _ �i
<br /> FIII out appllcatlon completely. �i
<br /> Owner 8 Contractor sign back of appitcatlon,notariaed
<br /> If over�500,_a Notica�of:Commencement Is rsquired. (A/C upgrade�over 3T500) �
<br /> .L�:•;'�.i},+.�.:.'vS;��'s`:
<br /> '° Agent(for the contrdctor)or�Power of Attoiney'(for the owner)would be�someane writh notarized letter from owner autlioriiin�same�' :, .';;,�-, °
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<br /> DVER THE.COUNTER,.PERMITTING-�--�:•-(Front•of-Applicetlon=Oaly) �-- ' " � ` � �• ,.
<br /> Reroofs if shingles Sewers Service Upgrades A/C' Fences(Plot/Survey/Footage) �� ' . :.
<br /> _,. __ _� ..__._�_,.�:: ,...._. ,� - - -- � � _
<br /> Drivewaya-Not over Counter if on public roadways.:needs ROW'' � � �� ��� ' ��" �
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