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813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
<br /> , , Bullding Departrnent
<br /> Date Recelved ' ., , .,:�:P.hone'-ContacY,for Permlttin - — ' •
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<br /> Owne�'s Name � (,(J cn �aS'1''"�7� Owner Phone Number ��3 � `d 7��`
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<br /> Owner's Address � � v 5 � A �-o o. ' Owner Phone.Number�
<br /> Fee Simple TINe6olderName • T� Owner Phone Number � �
<br /> Fee Simple Tltlehold�r,Addresa S w�2, -
<br /> JOBI�DDRESS S 100V� LOT# �
<br /> SUBDIVISIOFI • PARCEL ID# �
<br /> • , (OBTAlNED FROM.PROPERT1f,TAX NOTICE)
<br /> WORK PROPOSED .••.NEW CONSTR ADD/ALT Q� SIGN' 'Q Q �DEMOLISH
<br /> >B� INSTALL � :f,.REPAIR -•
<br /> PROPOSED.U$E ,. - Q , - SFR. �]_ COMM . Q •OTHER _ ' �
<br /> TYPE OF CONSTRUCTION"-� Q' �r-'BLOCK " [] FRAME ` '[� 'STEEL 'Q
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<br /> DESCRIPTION OF WORK' � `ey�L� �2 UJ b r -2, � /�/'o�� p�0& � �e IiZG,/�
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<br /> BUILDING SIZE • � �'SQ�FOOTAGE�. , _HEI,GHT . �
<br /> �BUILDING �$ s OD� ' y/�,UATION'OF`.70TAL.COySTRUCTION -
<br /> QELECTRICAL $ s ' AMP SERVICE. � ~�Q PROGRESS ENERGY [� W.R.E.C.
<br /> QPLUMBING $ -� '
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<br /> QMECHANICAL $ ` � - VALUAI'ION OF;MECHANIC�4L IN$TALLA'i'ION.
<br /> QGAS � ROOFING ,Q ;,_ SQECIAL.74Y�:Q=___,;OTHER,. ,�• , _
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QY�S. ,NO
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<br /> BUILDER COMP�NY:, _ � ....-, _ . , -; . , - .
<br /> 31GNATURE REGISTERED Y/ N , ' °.:��FEE CURRFKti '' '"Y`d N`' ` � -
<br /> Address �. :,: . •t�i� �`� �;License,#f�: ,,�; _ ,', � ,s .—�
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<br /> ELECTRICIAN; -- , . , � • . , i_�COMPANY'°` .. .'r==i;��:. ;'r � _ " - _ ,
<br /> SIGNATURE� � `REGISTERED u Y/ N FFE:cuRrtEf��" _'Y/N , - '
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<br /> Address� ._ .. . .,_ � . -� ,_.: a . � - • 'a� � :Llaensei#v� .. -- - , . �,
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<br /> PLUMBER � �_" r, .. .C.OM.P,ANY �.,.:::�:.� :e ,,: �:;;:,. .: :r,a ,,_,. .
<br /> SIGPIATURE'� .' - , . , - � . . ' L•
<br /> 'REGIS.TERED .,Y./,-N,� ,f�:cuw��: Y=/.N.
<br /> Address - ' . , � , . '`' " ' ;License#r �`. _ . .- -c �_
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<br /> MECHANICAI:� - . , ' • ., ' �'' � �COMPANY ' " ' ` ' � � - . , _ • i
<br /> SIGNATURE.- ,: �°s; �� LL ,. ,. � _ . ;,>� ��:.' � ., ; .. ,
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<br /> GISTERED Y:/,N ,',�� E�cuRaEn:. �Y./-N:.
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<br /> Address�'.. :�� . . .,,ra:'; ::,�.°. , r: .. _ .. � , _ ,. .,- . ,,, � - ;L , , - , , �
<br /> e� License# �k� _ . .,.
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<br /> OTHER n; .�: . „ _ ' ' .,. ... -_ : - . , �::. ' .� .
<br /> ,C`OMPANY . . ,... . _
<br /> SIGNATURE•_ . - ,�' _. .. _ -�.., . , .t. _ �;>,.,. _. , -
<br /> �REGISTERED� Y/ N�.,.. ��e'Cuw��'• Y%N
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<br /> +�45�� '�{S. � .� . ..... .. . . - - .. . - . . . , ._ .
<br /> Addre88 �, h[',;" - - :�.�.�,�° �1• - Y;r,; ,i_:. ..�.,�. • y •,.-
<br /> "Licen§e#'�
<br /> ) 51 k.::_'_ d::.�t�. . .. . i:'. ' ' : . .
<br /> RESIDEN7IAL„�;,';;;AttagFi'(2)aPlot;Pians',�2 sef§�<of.�Bu�ld(n`: w F �,'`'�' � ,'` '`' � . f.`'� ,'� � � . �;� � '. " �
<br /> ;:( ) g''Plans;'(.1�)set'of�Energy=Forms;�R-`a1N'Per"mlffor=new�construcfion,
<br /> �Aflinimumf�en�(=,1A)�wo,rl4ingyde�ys�after„submittal:d"eCe{;;;Requlred onsite;�Constiuc8on�l?lans;Stormwater Plans w/Silf Fence inslalled,1 '
<br /> �y ��Sanilary FedllU,es;&'s1„dur,��pster•�„Slte��Worir�Pertnit�for,sutidivislons/Iarge�proJectsr=�.•>� ' �iz• '-' - - ,� _. -�w �
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<br /> COMMERCIAL Attech(3)`coinplefe�sets`of'Building"Plans'plus a Ufe§afety Page;(1)set of Energy Forms.R-0-W Permitfor ne�ticonstruotlon.• � '
<br /> Minimum ten(10)waricing days after submlthal date. Required onsite,ConsUucNon Plans,Stormwater Plans w/Silt Fence Installed,
<br /> . Sanitery Facilttles 81 dumpster.Site Work Permit for all new:pr�ojbefs:All commerc(al.requlrements_must meet compllance'"4J ,
<br /> SIGN PERMIT AttaccFii'(2)sets ofEnginearedsPlans:,,::v.,;;�sr;-::::::;�... ..: . _ ..- •.. •_ • - �
<br /> "••PROPERTY SURVEY requlred fQr ali NEW constructlon._ _. -
<br /> Dl�ections: ...��;���.,.,� , - ,,.�
<br /> FIII out applicadon wmpletely.
<br /> Owner 8 Contractor slgn back.of appltcaUon,notarized
<br /> If over�500,_a,Notice_of:Commencement la requlred. (A!C upgeades over 57500)
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<br /> " Agent(for the contraictor)or Power of Attoiney'(for Uie o'wner)��vould be soriieone wlth notarized letter from owner authodzing same
<br /> DVER-THE:COUNTER=PERMITTING�••�--�;-(FronEof-AppllcatiomOnly) --- " " " - " �
<br /> Reroofs If shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage)
<br /> Drlvewaya-Not over Counter if an public roadways.:iieed`s ROW � ,;.,,:,,t...�,,.�,..:�,:,:.;_..-.:,� -..�.,.�.__ _.�...
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