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<br /> $73-?8a-ao2a �City of Zephyrhills Permit Application Fax-813-780-0021
<br /> • Building Department
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<br /> Date Received �� Q�^� p�one Contaat for Permittin
<br /> 9 �,
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<br /> Owner's Name �� � Owner Phone Number
<br /> Owner's Address ���� ��d(/�✓" ��'J`"• �.g � /�i�(lS�i�� ✓�3f�bWner Phane Number �� �
<br /> Fee 8imple TiNehofder Name �� � Owner Phone Number �� �
<br /> Fee Slmpie Titleholder Address
<br /> JOB ADDRESS .l� .J r!1/-� G<{1� ��l�� r`�i f I� �� ��5��/ LOT# ���
<br /> SUBDlVISION � � PARCE�tD#
<br /> (OBTAINED FROM PROPERTY TAX NOTICE) �
<br /> 1N4RK PROPOSED e ., N8W CONSTR 8 ADDIA�T �� StGN � Q DEMOLISH
<br /> INSTALL REPAIR
<br /> PROP..OSED"USE Q = SFR Q COMiU! L� QTHER
<br /> TYPE"OF CONSTRUCTION [� BLOCK • [� FRAME 0. STEEL Q
<br /> ._ `�
<br /> DESCRiPTiON OF WdRK lGQ. e:� � �� '� ` � / ''~�, ��'
<br /> BUII:D1PiG SlZE � � SQ FO{?TAGE�� HEIGHT ,��
<br /> QBUt�DING ��� �""'� �q�,UAT10iU�OF TOTAL CQNSTRUCTI{)N
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<br /> •:[.�EI:ECTRtCAL �� AMP SERVICE Q PRCIGRESS ENERGY Q W.R.E.C.
<br /> [�P�UMBING �S �
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<br /> QMECHANiCAL $ VALUATIQN OF MEGHANlCAL INSTALLATION � t ��z��
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<br /> �GAS ROOFING Q SPEClAl.7Y � QTNER
<br /> FINISHED FLOOR EI.EVATIONS � FLOOD ZONE AREA QYES NO �-p��
<br /> BUIE.DER COMPANY
<br /> SIGIdATURE REGISTERED Y"/ N FEE CURRE� Y/N
<br /> Address "License# I. �
<br /> ELEG;fRFGiAN CQMPANY
<br /> SIGNA'TURE REC�ISTERED Y/ N '' FEE CURRE� Y/N.
<br /> � Address - License# � � �
<br /> �,. .
<br /> PCUMfBEIt,,., COMPANY
<br /> �SIGNATURE REGISTERED Y.•/�N .FEE CURRE� Y/N
<br /> Address License#`-�! �
<br /> ., , .,�� �
<br /> �'MECHAt+lICAG ' � COMPANY
<br /> " SIGNATURE"''� �� ' REGISTERED , Y/.N , FEE CURRE� . Y/N '
<br /> Add�e`ss4' ' � - L•icense.# � �
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<br /> v o���: �:,�<. �, ` ` connPaiavv :�� ���-�',� .�L � .
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<br /> '1-'SIGNATUREcd;-�� �"�' - i 'REGISTERED /`N. �e cu ..n� Y/N
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<br /> .,. Aaa��s�{,:. 3���: i!�' �-1..-,�.�� c)'`" ��e .lL .!'��FllS G' 33..5'-�'/' t�aen'se# �'C:'!'�..��aC�.rZ �
<br /> �'I2ESIDENTF��L.°�:,` :;4ttacfi';(2).:Pta#`:Rlans;;(2�};sefs of'Bisifding-i?lans;(1�}'set of�Eneigy;Fortns;R=O=t�V Peiritit_for new.consttuctio�,
<br /> :';�;�'' r�f��,,:;fxa;�.�..:,-,;Minimum��;en�(r1 Q);wor,king�,days�;afte�su�iriittel:date. �Required''onsite;Cons4ructlorr Plans,.Stormuirater�Plans w/Silt Fence installed,
<br /> ,M.....0 n.� . , .. � . . �
<br /> �.- Sanita.ry,;F{aeilttiss;&��•t<.dumpster•;-Site.WorkPerrtiiYfor•..subdivisions!large:projects. � -
<br /> ' ]ry.:1:i=...i..fr�.�...• ��_
<br /> ��;�GOMNlERCiAi. At#acfi(2)'compiete'sets of'Buitdtng Ptans plus a�ife Safery Page;{t}set of Energy Forms.R-O-W Permit for new�constructian.
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<br /> 't'�.. . Minimum ten(10)working days after submittal date. Required onslte,Construckion Plans,Stormwater Plans w/Silt Fence installed,
<br /> Sanitary Fac3lities&1 dumpster._Site Watk Fermit fot�al!>new p'ro�ects.Rf!commercial requirements must meet compllance
<br /> ;:�.�tSIGN�PERMiT Attacfi(2}:sets.of.;Engineered;Plans.,�� :. •- ' '
<br /> ''�;�'"��- •""*PROPERTY'SURVEY reguired for,all,NEW canstructfan.
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<br /> ���;Di�ections: .. _.:- :�; •
<br /> ���� �� 'Ffll out:application completely.
<br /> t}wner°&�Contractor slgn back af application,notarized
<br /> , , �If aver'$2500,a Notice.af Commencement is requirad. (AlC upgrades over 57500) ..
<br /> �:��; �'", ��y�t�'..':-.z"li
<br /> .Y AgenY(for°ttie�contractor)�arPower-of`Attorriey'{for'ttie ow"ner)`wottld be someone with notarized letter fr+am ov+mer authorizing same
<br /> ;,�OVER':THE'CQUN7'ER�PERMIT,TING, �..._:.�(copy,of<contract<r�equi'red) � � ' '�
<br /> "`":Re�oofs if sfiingles Sewers Service Upgrades A/C.��'� -.Fences(PIot/Survey/Foatage)
<br /> Drtveways-Not over Counter if an public r'oadwrays::neecl"s R01N'' �
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