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813-780-0020 City of Zephyrhills Permit Application J�� FaX-e�3a8o-ooz�
<br /> • Building Deparkment
<br /> ,� w
<br /> Date Received � �
<br /> Phone Contaat for Permitting � / _
<br /> 4wner's Narne ,�.�JC'.�77 b s�. �\/ !� Owrner Phane Number �� ���� —�o �
<br /> Owner's Address �J�s � O�$ C � Owner Phone Number �� �
<br /> Fee Simple Titleholder Name �����„ �_..,�DJ t"S � Owner Phone Number �— �
<br /> Fee Simple Titleholder Addr.ess 3����' � �J v'��..
<br /> JOB ADDRESS ���7 O�5 �'���� ��'" •t� LOT# �_�
<br /> SUBpIVIS10N � � PARCE�ID#
<br /> (OBTAINED FROM PROPERTY TpX NOTICE)
<br /> WORK PROPOSEf} . NEW CONSTR ADD/At�T � SIGN [� � Q DEMOI.ISH
<br /> � � INSTALL 8 REPAIR
<br /> PROPOSED'USE Q SFR Q GOMM C� 4TEfER .
<br /> TYPE`OF CONSTRUGTION � BLOCK • [� FRAME � STEEL Q
<br /> DESCRIPTION'OF WORK 1/ t�'�t c� I �v �l +,-h� i �� �'�
<br /> BUILDING SIZE � � SQ FOOTAGE� , HEIGHT•• � �`�"�
<br /> �BUILDtNG ����` �� VACUATION"OF TOTAL CONSTRUCTION
<br /> QELECTRiCAL . � � AMP SERVIGE Q PRC)GRESS ENERGY Q 1N.R.E.C.
<br /> OPLtiNiBlNG `>� � •
<br /> L �
<br /> QMECHANtCAL $ VAl.UAT14N OF MEGHANlCAL iNSTALLATtON `��
<br /> QGAS Q RQOFEN� [� SPECIALTY [� OTtiEFt
<br /> FINISHED FLOOR EI.EVATIONS ��� FLOOD ZONE AREA QYES NO
<br /> BUILDER .�������_,��.,�—� COWIPAIdY
<br /> SIGNATURE � '='' REGISTEREp Y"/'N FEE CURRE� Y'/N
<br /> Address "Cicense# �— ��
<br /> , "ELEGTRiCI,AN ,. CONiPANY ` .
<br /> SIGNATURE REGISTERED Y/ N �FEE CURRE� Y/N
<br /> ' Address' - . � License.# � I
<br /> ;�., _ ,
<br /> PLUMBER.,., �CdNIPANY � '
<br /> SIGNATURE •-REGISTERED• = Y-/"N-"' ',"` FEE CURRE� Y/N
<br /> l�ddress_ � License#��� �
<br /> ; .MECHANICAI:' ' , COIUIP.ANY '
<br /> ' SIGNATURE' � REGISTERED Y/ N'. ,= , FEE,CURRE� ; :' Y'/N -
<br /> F , .
<br /> Add're"ss��' ' ' �` Liaense-# �.- I
<br /> �F;�;.�.f , . . .
<br /> �°..OTHER�`���"•- �� COMPANY
<br /> :;``.SIGNATURE3�_<� :x - � - REGISTERED � . Y/ N_= FEECURREK Y/N
<br /> Address�r.. ��= -;�-_ _ - ' License# �� �
<br /> =YRESIDENTIAL�;;�� `�Attach�;(2);PIof;Plans;``(2)':sefs�of Building�`Plans;�(1�)°set of'Energy,Forms,,R=O,-VN Permif fornew.constr_`vction,�
<br /> _ ���-,,; `�-��.�;:�r,�Minim,um;ken,(10,)avrotkingsday�:aftersubiinittal�tlate.�Required'onsite;Con`struction Plans;Stor`muirater Plans w/Silt Fence installed, °
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<br /> v • � Sanita,;Facllities,8��1_;dum ster,•;:Sr#e�Work Rermit for:sabdivisionsAa e� r'o'ects" �
<br /> ;,•r �Y,.. ; R.r_ . �. p_!_
<br /> :�;wC.OMMERCIAL Attach�(2)�`compleCe sets'of"Building�Plans plus�a'Life Safety Fage;(1)set of Energy Farms.R-O-W Permif for new cdnstructian.
<br /> Minimum ten(10)working days after submittal date. Required onsite,Constructlon Plans.Storrnwater Plans w/Silt Fence installed,
<br /> �M�`�' ` Sanitary Eacillties&1 dumps#er..Site,Wartc Pertnit'fox�all-ner�r projects.A}I commeraal requirements must meet compliance
<br /> r-:•�. . ....,...
<br /> �.'=SIGN;('ERMIT 'Atkaicfi'(2)sets:�of�Engineered�Flans.<� .. , . . �
<br /> 'i��+�• **""PROPERTY SURilEY required fo[.aII,NEW.ccihstruction: _
<br /> �'`�i:'Di�ections: .-�rK � , ., , —
<br /> �''= � �Fi{I%out app4icatian camplete4y.
<br /> �� t}wmer.&:Contractor sign.back of apptication,natarized �
<br /> ,y;__ .
<br /> �. If over$2500;a Notice.of Commencament is required. (AfC upgrades over$7500) ,
<br /> �:,:,.w:.,,�,:,.;r�.
<br /> ;"''�" AgenY(for`th'e�contracfor}°orPower of`Attome}({for'tEie owner}wtrutd tie someone with notarized letter fram awner authorizing.same
<br /> ;s`QVER:THEFCQUNTER`�PERMIITING, (copy,of•co�tract required) �
<br /> :�R'siciofs`if.shingies Sewers Service Upgrades A(C FencQs{PlotlBurveylFootage)
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<br /> : Driveways=Not aver Counter if an public roadways'fneeils�RO�V�;'�-' ��, , ��"���������%^'��-���%�r���`��
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