|
1
<br /> �
<br /> 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0421 I
<br /> • Building Department
<br /> . +
<br /> Date Received �–y -- 4 � Phone Cantact for Permitking � �1� 8��S �° – '`�.O � �
<br /> Qwner's Name �0� �A�SZ Owner Phane tdumb�r ' vJ�L`"
<br /> U6
<br /> /^Wwner's Address ����5��Pr I��-S�t9� � +2 Owner Phone Number
<br /> tf'
<br /> Fee Simple Titleholder Name Owner Phane Number
<br /> !
<br /> . ,
<br /> �
<br /> ,.. 1
<br /> Fee Simple Titleholder Address
<br /> �OB ADDRESS �`�c�J �.A K G' S t'f} � i�� LOT# L..�
<br /> StiB�l�lISIOR! �t�1E+2s �1�f�1L � PARCEI.ID#
<br /> (OBTAINED FROM PROPERTY TAX NOTICE)
<br /> WORK PR�POSED e .. NEW CONSTR 8 ADD1,4L,T [� SiGN � � Q DEMO�ISH
<br /> INST'ALL REPAIR
<br /> PROPQSED tISE - Q = SFFt Q CQMM � 4THER '
<br /> TYPE'`OF CONSTRUCTION Q �BLOCK • Q FRAME � STEEI. Q
<br /> ��
<br /> DESCRIPTIQN�OF WORK �• �L R C� � i � i�o SC� YI ' � ��u�'�""'�
<br /> BUILDING`SIZE � � SQ�OCITAGE��� ME{�HT �
<br /> •f 5-'
<br /> � ��������{_ f� � �
<br /> �BUII.DtNG � �..., VALUATIOiV�OF TOTAL CONSTRt1CT10N
<br /> v
<br /> .:QEl:ECTf21GA� �� AMP SERVICE Q PROGRESS ENEFtGY Q W.i2,E.G.
<br /> QPLUMBtiVG � �
<br /> OMECNAi�I1CAL �> � VAlUAT14N QF NfEGHANICAL INSTA�LATIOi� �G/k�"�
<br /> 1 ' '
<br /> QGAS Q 32QQFI�VG [� SPECIA�"fY C"� 4T#iER �
<br /> FINISHED FLOOR ELEVATIONS ��� PLOOD ZONE AREA QYES NO
<br /> BUtLDER � _ j� j COIVIPANY �L��
<br /> SIGNATURE (:5��� REC,ISTEREp Y`/ N FEE CURRE� Y/N
<br /> �4ddress -License#"� I
<br /> :ELEGI;RI,GiAPi COMPAIVY
<br /> - SIGNATURE REGISTERED Y/ N �FEE CURRE� Y/N.
<br /> .` Aildress' - ' License# �— t� I
<br /> °<•=r�>�., -
<br /> - P.CUMBER:;. Gt31lAPANY -
<br /> —'SIGNATURE REGISTERED Y•/;N,� ` FEE CURRE� � Y/N �
<br /> �4ddress License# �� �
<br /> .. , � l—�---
<br /> ..MECHpfi11CA�t�. COMPANY •
<br /> °'"SIGNATURE'' ' - � REGISTEREp <, Y/ N_ �� FEE GURRE�- . Y/N ' . I
<br /> , ,�,. .: : .
<br /> Aild�ess��° � � �, .' ' ` , . License.# � � �
<br /> .xus-',,� _ - ,.. .
<br /> > ,OTHER°�;;"` ` '• � C,OMPANY , �
<br /> ?..'SIGNAiTURE:;���;:� .^4` • ��� � REC31$TERED � �Y/'�N � FEE CURREK . Y/N
<br /> AddressrN �3 ,,,. ^ • ^ . . Licen`se# � �
<br /> i'd,;;,�:'... :.;;,»y,..,.—: .. ...; . .. ,� . . .: ,
<br /> �*"wRESIp.ENiT1,At:{;;:v':A#tacii;(2):P(6t?Fl�ris;'(2:).sets�of=Build�ng-P1ans;(13`set of=Ener�gY;Forms;'R':Q,-�til.Peimlt,for oew.constivcban,. �
<br /> ;�'�- : �'��:;r;x�.�,.,���;sMinimum:G,ten�(;10);workingcdays;:afte��sulamittalldate.'Required'onsite;Constriiction Plan's;Stoi�nvirater Plans w/Silt Fence inskalled, ,
<br /> = ,. , , .; . •
<br /> "x Sanitasy SFacilipes&31,�dumpste,,r•,°Sites,Wocic;Pertnit foc<subdivisia�isflarge;pfOjeGt:R: �- ' "' �
<br /> ^:'CONIAAERCIAL Attach�2)°comptete sets ofBuiliiing'Plans plus a Life Safefy Page;{1}se#of Energy Forms.R-O-W Permit for new construction.
<br /> � � Mlnimum ten(10)working days after submittal date. Required ansite,ConsUvction Plans,Stormwater Plans w/Silt Fence installed, �
<br /> � Sanitary Fac3tities&1 dumpsfer.Si#e Wark Pecmit foc�all new•p�ojects.A!1 cgmmerciai requ9rements.must meet compliance ;
<br /> �.:��SiGNcPERMIT "AtfacFi°(2)sets of3Enginsered`Plans.�f'�•�� � ' • � " I
<br /> F�'>_" "*"*PROPERlY'SURVEY r,. uired for.all,NEW.cpnstruction:
<br /> ,.,;,., v_ eQ__ _
<br /> �z�,:Di[eCEioiis: t:,;���„>;,�.~.. ..,,
<br /> %t:,'-' `Fill;out:application completely. �
<br /> '� . Glwner'&Contractorsigm tiack afiappticatian,notarizad , �
<br /> ;t:
<br /> �If over$2500,a Notiae:of Commencement is required. (A!C upgrades over$75QQ) �
<br /> �.-<sn:-�;,,z.� �
<br /> �'`*_' i4gent'(for'tfie�cont�actor)'�or�Power of'Attomey{for'tlie owrie�j woulc!be someone with notarized letter from awner authorizing same �
<br /> ....
<br /> ;.- ._ - -- _.
<br /> ,,. �_ . _.., , .
<br /> _ , _ _ ._.__ ..
<br /> , ,. .. _
<br /> .:< ... , ° r: I
<br /> '' R'.THECOUNTER�PERMITTING,,..-,_r(copy_of:contraat�required)"-'' V`'`•:; M
<br /> ,>,QVE_ � _ ':-� ` ' '' �
<br /> ��'Reioofs.ifsfiingles �Sewers Servlce Upgraid'e's A/C � Fences(Plot/SurveylFootage) , , , , , ,
<br /> :.
<br /> p.. , � • � , 1 , .. _
<br /> � .� -. . � . t i. 4
<br /> � , _ _a.. .. ........: � "�-_._ � _�� — . , , �fI �
<br /> - Driveways-Not over Counter if on:public roadways.:needs ROW � � - • - ' �
<br /> ,. . , . ... _ _. _ - �
<br /> t� ..-
<br />
|