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<br /> s�saso-oo2o City of Zephyrhills Permit Application Fax-813-780-0021
<br /> �• Building Department
<br /> R _
<br /> Date Recelved
<br /> - Phone Contact for Permitting'� —
<br /> Owner's Name ��� — ��,(:, � ��,� �Owner Phone Number 7�!�V /�V j
<br /> Owner's Address ���.,3 � PJ �/fi> >d�"itLS�G � Owner Phone Number
<br /> Fee Simple Titleholder.Name Ouiner Phone Number
<br /> Fee Simple Titleholder Address
<br /> JOB ADDRESS � ;7� �/1/,L LL � �� �� LOT# �
<br /> SUBDIVISION ^ ' ` 1� PARCEL ID#
<br /> _ (OBTAINED FROM PROPERTY TAX NOTICE) �
<br /> WORK PROPOSED e „ NEW CONSTR B ADD/ALT Q SIGN Q � Q DEMOLISH
<br /> INSTALL REPi41R
<br /> PROP.,OSED USE Q SFR Q COMM 0 OTHER .
<br /> TYPE'.'OF CONSTRUCTIOId Q BLOCK •• Q FRANIE 0 STEEL Q
<br /> • �-� `' l
<br /> DESCRIPTIOId OF WORK ���-J-'�`b"�.� ( / li �C 'Z— �,1.��'
<br /> BUILDING SIZE O� � SQ FOOTAGE� HEIGHT ,
<br /> i .f.�,.�.5_.
<br /> BUILDING $ .� VALUATION'OF TOTAL CONSTRIJCTION
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<br /> QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
<br /> OPLUMBING $ �?/I �
<br /> � �
<br /> OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION ���` ��CZ�
<br /> QGAS Q , ROOFING SPECIALTY �
<br /> Q Q OTHER �Sl`i-�..P �'�'
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
<br /> BUILDER ��� � COMPANY r��� G�/L���Z?
<br /> SIGNATURE REGISTERED Y/ N FEE CURR�� Y/N
<br /> Address License,#
<br />� ...`.1" . ' , _ , .
<br /> . �ELEC,TRICIAN , COMPANY �
<br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N.
<br /> Jrr,. - . . . , ,
<br /> Address . License#' °�
<br /> +5, •• ,
<br /> PLUMBER:,,.. , . - . - ..COMPANY-�,�.: -
<br /> •SIGNATURE - -ttE��sTEREo • Y•/�N:•`' ' •FEE CURREK � Y/N '
<br /> •, .
<br /> Ad'dress ' License# .�.
<br /> _. ,;, ,
<br /> ;".MECHANICAL ' � COMP,ANY - �
<br /> �:'SIGNATURE`y'"� �� ` •` ' ' REGISTERED ; Y/ N , a , FEE cuRRen , Y�/N ' .. .
<br /> Aild're'ss-•'� � � � '" L-icense.#
<br /> - 'Y:�i�� � . . .. . . ; _.
<br /> O?HER��' , .' . ". , • . „ " 'COMPANY .
<br /> �:SIGNATURE,; ._ _ ' ,` - .
<br /> ' :REGISTERED , Y/N.: FEE CURREK Y/N - . ,
<br /> � i N - .-. . . .. . . . . � . . . .
<br /> ,_ ,'Address<. _ ,.�.,: - � , . . , , : - License# - ,_ - . _ , .
<br /> ;.,Lr: f•, - . - -
<br /> -:,RESIDENTIAL'^- :Attach'2`.Rlo"P,f: : �,. " >;°�.c.c:..>'� :,,,..'•- -- , .� . . . , •. 1
<br /> „�; _ a„(_) . t ans�;;(2):sefs�ofBuilding�Rlans;�(�1�)�setof^Energy,Forms,:R:0=V1lPerr`riitfor,new`,construction;.._�
<br /> q-„.:��.---:�Minimurri'�_tem,i1'Q viior.kin zda�`s�after�su6mittal:date:`Re uired�onsite�Constru'ction'`Plans� �oimu'vat'�r Pla w•�
<br /> - ,i�,;,,; . , ..(. )._. , _g _y_. q , ,.St e ns /Silt Eence:;installed,.,
<br /> � - = ,�, . _ .
<br /> - .- � �� Sanitary,F.acilities;&L1;,du'mpster SiferWork.Fermit:for,subdivisions/large`p,r,ojects .:.: = P=�'• � � . � -
<br /> :.�,COMMERGIAL' Attach�(2)complete sets:of Building Plans-plus a Life�Safety Page;,(1),sefof Energy Forms:.R-O-W Permit,for new constfuctlon. �
<br /> - � � � Miniinum ten:(10):working,day,s:after,submittal date. Required onsite,.Constii�ction Plans;:Stormwater Plans-w/Silt Fence,fnstalled,�—,--• _<�-
<br /> � ' ' Santtary F.aciliNes��1,�dumpster`:Site.Work Pemiit:fo��all=new:p`rojects.All_commercial requi�ements.must meet compliance �
<br /> ';�. SIGN�PERMIT -�Fittach(2)'sefs of:;Engineered Blans:}��::_�,,.. ' .- • � ' ` " - '
<br /> � - " ' - ""PROPERTY,Sl1RVEY required for;aIf:NEW constn�ction::., _ . - _ . __ ,
<br /> .;.'. _. _ , - �
<br /> r��Directions: , , • � ,.,,;.,;,: _ -. � . , - - .- . .r . . .� - , • � "
<br /> . Fill:out'a lication,bom letel-
<br /> PR. P. .Y•� - _
<br /> � '_Qwner'&Contia�tor"sign:backof;application,notarized� - , ; ;�.�.,ti:� . - ., -
<br /> .° ,�.� If over.$2500,a Notice of Commencement;is.required.':(A/Gupg�ades.over$7500)'=� � •
<br /> : "� .Agent(for'#h'e�cont�actor)'orPower;of:Attomey:(for.:tFie.owner);would'tiesomeone.with'notariied:lettec�fromowner;a`utFioiizing�same =-��: < .,_
<br /> ;�OVER',T;HE'COUNTER;PERMI]'TING:��;;�����,(copy_�of'aontraet=�equired);:;�''�'� '' ' ,. - �- - - `�" , , , , -. , � :' ,
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<br /> !';Reroofs,if'sfiingles - �, ��Sewers �.Service Upgrades.A/C.�, ��F�nces_(PIoUSurvey/Footage) � � � ' '-.. � ,
<br /> � _.: .r �_::�;:.,- „ :.:_.;:. ;. ,:_. :' .,,- ,_ : .. ,
<br /> �,.Driveways-Not over Counter�if.on:putilic roaiiways:wneec�s`ROW„�- �. � � ' '�"`�"" �� �-� -. - . ., ,
<br /> ,. � , " - ✓ ,� � ��«
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