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813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
<br /> �'� ` r • Buiiding Department �
<br /> Date Received Q�- � _ � �
<br /> Phone Contact for Permitting �
<br /> Owner's tdame � J� Owner Phone Number ���� ���/7 O
<br /> Owner's Address � � /�N�.r/` .0 Owner Phone Number
<br /> Fee Simple Titleholder Name Owner Phone Number
<br /> Fee Simple Titleholder Address
<br /> JOB ADDRESS �� �� C��I�i�GU�!�� LOT# �
<br /> SUBDIVISIOfd � �!�/ PARCEL ID# /(✓ � � b��D �D�D �
<br /> (OBTAItdED FROM PROPERTYTAX NOTICE)
<br /> WORK PROPOSED e NEW CONSTR� ADD/ALT 0 SIGN Q Q DEMOLISH
<br /> INSTALL REPAIR
<br /> PROPOSED USE Q SFR Q COMM � OTHER
<br /> TYPE OF COIdSTRUCTION 0 BLOCK • Q FRAME � STEEL Q
<br /> DESCRIPTION OF WORK �E`� �/C �AN ' � '��� o� G�Ti'/ Dii`�/U�S � D� I���+
<br /> BUILDING SIZE SQ FOOTAGE� HEIGHT
<br /> �BUILDING $ VALUATION OF TOTAL CONSTRUCTION
<br /> QELECTRICAL $ AMP SERVICE 0 PROGRESS ENERGY Q W.R.E.C.
<br /> OPLUMBING $
<br /> [�MECHANICAL $ �����a� VALUATION OF MECHANICAL INSTALLATION
<br /> OGAS Q ROOFING Q SPECIALTY 0 OTHER
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES NO
<br /> BUILDER COMPANY
<br /> SIGIdATURE REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address License#
<br /> ELECTRICIAN COMPAWY
<br /> SIGPIATURE REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address Cicense# �
<br /> PLUMBER; COMPANY
<br /> SIGNATURE REGISTERED Y=/ N FEE CURRE� Y/N
<br /> Address � License# � �
<br /> MECHANICAL � � COMPANY A�ieS /�O ��1J�/y�t� ' �C°�
<br /> SIGNATURE REGISTERED Y/ .fV FEE CURRE� Y/N
<br /> Add�ess � � �����`/�'A) , / G'"/�/L.L��� ��,c„ �3� _ License.# �����7 �
<br /> 07'HER COMPANY
<br /> SIGNATURE REGISTERED Y/N FEE CURRE�' Y/N
<br /> Address � - License#
<br /> , RESIDENTIAL Attach(2).Plot'Plans;(2)sets ofBuilding Plans'(1)set oYEnergy Forms;R,O-W Permit for new.construction,
<br /> . Minimum ten�(10)working:days after.submittal date. Required onsite,ConstrucUon Plans,Stormwater Plans w/Silt Fence installed,
<br /> Sanitary:Facilities&1.dumpster;Site Work Permitfocsubd'ivisions/large projects
<br /> COMMERCIAL Attach�(2)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction. _
<br /> Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans-wl Silt Fence installed,
<br /> Sanitary Facilities 8�1 dumpster.Site Work Permit fo�all new projects.All commercial requirements must meet compliance
<br /> SIGN PERMIT Attach(2)sets of�Engineered Plans. -
<br /> ' '""*PROPERTY SURVEY required for aII.NEW construction.
<br /> Directions: � -
<br /> Fill out application completely.
<br /> Owner&Contractor sign back of application,notarized
<br /> If over$2500,a Notice of Commencement is required. (AIC upgrades over$7500)
<br /> " Agent(for the'contractor)or Power of Attomey(for the owner)would be someone with notarized letter ftom owner authorizing same
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<br /> OVER THE COUNTER PER�jIITTING}��r,c,�:(copy{of�cgnVact requlr,ed)� ��`°�'�'��"�� ,,,:, {t
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