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s�saso-oo2o City of Zephyrhills Permit Application Fax-813-780-0021
<br /> - , , ' Building Department
<br /> Date Received �, � � .phone Contact for Permitting�= ���� ��p -- �p /� _.
<br /> Owner's Name � D � }� �0 F�J �t � Owner Phone Number , 3�5— � �
<br /> Owner's Address . 3 l 3�� �U-e, Owner Phone Number �l���' � � 1
<br /> Fee Simple Titleholder Name N'����(iyiGL,��/'✓� Owner Phone Number �
<br /> Fee Simple Titleholder Address �G�7'7/{�(, ��"�'
<br /> JOB ADDRESS ��� �"��'�Uf/`t/ LOT# �
<br /> SUBDIVISION PARCEL ID#
<br /> (OBTAINED FROM PROPERTY TAX PIOTICE) �
<br /> WORK PROPOSED � .-NEW CONSTR� ADD/ALT 0 SIGN Q Q DEMOLISH
<br /> INSTALL 'REPi41R
<br /> � PROP.,OSED USE Q - SFR Q COMM Q OTHER
<br /> TYPE'OF CONSTRUCTION Q BLOCK • Q FRAME. 0 Sl'EEL Q
<br /> " � + ,n,, ;�
<br /> DESCRIPTION OF WORK .�/J'1� �P ���� ���vr��
<br /> - BUILD.ING SIZE SQ FOOTAGE� HEIGHT •
<br /> �BUILDING $ ��D � VALUATION'OF TOTAL CONSTRIJCTION
<br /> QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
<br /> ;�
<br /> QPLUMBING $ �
<br /> QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION �c�, �
<br /> . L�� �> �
<br /> QGAS Q ROOFING Q SPECIALTY 0 OTHER
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
<br /> , BUILDER �/L fy2�2��/ f COMPAfdY 4���%�JL�
<br /> SIGNATURE �"� REGISTERED Y�/ N FEE CURRE�. Y%N
<br /> Address ` -License#
<br /> ELECTRI,CIAN COMPANY '
<br /> '„ =SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
<br /> ' Address - License# �
<br /> " .J�y:.,.`.
<br /> PCUMBER.;_ COMPANY , �
<br /> � '•SIGNATURE -REGISTEREO ; Yr/=N " ,FEE CURRE� Y./N
<br /> Address , =License#- :
<br /> " MECHANICAL , COMP,ANY
<br /> �'` SIGNA7URE`' ' REGISTERED ,' �Y/ N , FEE CURRE� ,_ Y/N �
<br /> Add�ess�-� _ License#
<br /> -".'iF.» . -
<br /> ':, OTHER" r°�'' �� COMPANY
<br /> �;�SIGNATURE:i�.�. _ � " • rte��sTErtEo , Y/:N FEE CURREK Y/N
<br /> _ �+. , . .
<br /> ` Address: � '� " License#
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<br /> �;;:.RESIDE.N,TIAL�k�`; Attach';(2):.PIot�P.lan's;'(2)"set's•of�Building�Plans;(1�psetof�Energy�Forms;R=.0-V11 Permitfornew.construction,
<br /> _ �� �,:^-y ;•-.Minimum;tenr.(r1U)working`;days after sutimittal.date.'Requiretl`onsite;Constr'uction Plans,`;Stormwater Plan"s w/Silt Fence installed,
<br /> _ �,: • 'Sanitary�kFacillties,;8;v1;�dumpster;.Site;,Wor:k Permit for;subdivisions/large'.p'roject§� - - - -
<br /> '°rCOMIUIERCIAL Attach�(2)�compleCe'sets'of'Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construcUon.
<br /> Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
<br /> ' Sanitary Facilities 8 1 dumpster.Site Work,Permit foF%all-neuir p�ojects.All commercial requirements must meet compliance
<br /> ��:`:SIGN+PERMIT Atfabh(2)�sets of.tEngineered'Flans.�:- '
<br /> '��:4- ""PROPERTY SURVEY[equired for aII.NEW.construction.. �
<br /> ���_ - -- - -
<br /> :�;.
<br /> �;"Directions: r�>;���-`=.•
<br /> ` , �Ftll:out application completely.
<br /> Owner&Contraotor sign back of application,notarized
<br /> ' Ifi bver�2500,a Plotice of.Commencement is required. (AIC upgrades over$7500) _
<br /> '.:....- �:-z...:,,.t:,;�.e
<br /> AgenY(for'`th'e�co'nt�aotor)�or�Power�ofAttomey(for'tlie owner)would tie someone with notarized letter ftom owner authorizing same
<br /> i';;OVER�THE'COUNTER`PERMITTING. ... -(copy_of-contract-required) '� ` �
<br /> ''.Re�oofs if sFiingles Sewers Servlce Upgrades A/C Fences(PIot/Survey/Footage)
<br /> :. ..__... ..,.. _ _
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<br /> � Driveways-Not over Counter if on public roadways..needs ROW %•-�"'-�'%� -����r-�!='����'���! __
<br /> . ,. , ..:,.,._ , •r:�;:.::!r:., �,;
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<br /> 'c;.,-...Y..:,�,..... -..�a-- .v. .....c Y.-_ , „o-:s�,;..:,
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