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sts-�so-oo2o City of Zephyrhills Permit App(ication FaX-s�aasaao2�
<br /> • Building Department
<br /> "� e
<br /> Date Recelved Phone�Cotztact for Permitting '� --
<br /> Owner's Name �(f' i �C.-�' Owner Phane Number
<br /> Owner's Address Owner Phone Number �— �
<br /> Fee Simple Titleholder Name ��� ���9�.�?�iG. Owner Phane Number ��! "'O���-��r.� t
<br /> Fee Simple Titleholder Address
<br /> JOB ADDRESS ��� C.J—ibt� iv 1—G°' �'�� LOT# [�
<br /> SUSpIVIS1QN �� � PARCEl.ID#
<br /> (OBTAINED FROM PROPERTY TAX NOTIC6) �
<br /> WORK PROPQSED e .. MEW.CONSTR 8 ADDIA�.T � SIGN Q Q DEMO�ISH
<br /> INSTALL 'REPAIR
<br /> PROPC}SED USE Q - SFR Q COtviM �C� OTNER
<br /> TYPE�:dF CqN$TRl1CTION Q BLOCK • � FRAME �. STEEI. .Q
<br /> DESGRIPTIQN OF WORK ^ �- ^` �� /� '�- � �� -7�U
<br /> BUIL�IING;SIZE � T��� � SQ FOQ'PAGE C�������T�, �
<br /> OBUIl.DING $ `
<br /> ��('j(j � VALUATION°OF TOTAL CONSTRUCTION
<br /> �J
<br /> .-QELECTt21CAL � � AMP SERVICE Q PFt4GRES8 ENEF2GY Q W.R.E.C.
<br /> r
<br /> QP�UM8ING �— �
<br /> QMECNANICAL $ � � � � VAlUAT10N OF�11ECHANICAL{NSTALLA'fiON �L��
<br /> � �
<br /> Q,GAS Q FtOQF11VG Q SPECIAGTY � OTHER'
<br /> FINISHED FLOOR ELEVATIQNS FLOOD 20NE AREA �YES NO ����
<br /> •.BUtLDER ��� .--- CC3MPANY �r
<br /> SIGNATUR� REGISTEREp Y/ N FEE CURRE� Y%N
<br /> Address �Liaense# � �
<br /> ,..,ELECTRtC1AN ,: COlNPANY
<br /> ... SIGNi�17URE REGISTEREp Y/ N ' FEE CURRE� Y/N. '
<br /> � 'Address� � - License# � � I
<br /> F.LUMBER.;: . COMP,4Mfi
<br /> 'SIGNAT.URE 'REGISTERED , Y�/'.N, . FEE CURRE� Y I N
<br /> � Address Licerise#�•�— �
<br /> ; .,;, � ��-�
<br /> NIEC�1��11NICAL•", ,� , —''"� COMPANY t-� � Z
<br /> `' 'SIGNATURE'" ' ' ' � REGISTERED � Y/ N_ •� , FEE GURRE� . Y I N
<br /> Add'ress� '� - License.# � �
<br /> ;
<br /> �;ir.t.,� � . , . .
<br /> OTH�;t��.,.., � , „ ` ' COMPAi�tY
<br /> `�SIGNATURE���'��s� ' ' ' REGISTERED Y/�.N FEE CURREK , Y/N
<br /> Address�.-,. - - _.<< . . x Cicen`se# � �
<br /> ,s,
<br /> 1.�, , . . �,.:� -
<br /> :,:::=;== •.:. . . .. , .., _. _; ..� •;.:,; ,. :- .
<br /> ,.;� � ,�, � , � ,,,{..,�,,.
<br /> *;,-.RESIpENTiAl:`;,�:: ;Attacfii::;(2);Plot';Plans;::'(2�}:sets=�of�Buildirig�Flans,`(1•}°set of�Energy�Forms;R=O-�I.Perri��it,for new,constiuctian,
<br /> � :s . :•.-�,Minimum ten.(;1p,,),inwo,.rkiitg:days�after'su�"riiittal�tlate.���Required'onsite;-Gon`struc#ion'Plans,`.Starrnwater�Plans w/Silt Fence installed,
<br /> i. 3,a..,:', 'x.M --ry, • • • v. .. . .,
<br /> = ��".' .' Sanita,.ry.;Faci#ities.F&�:1_�dumpske.r•,.Site<,W.,.ork.Pe�rtiitfor•:subiiivisionsllarge`proJects � '=` � , , '� �
<br /> ��COMMERCii�AL Atfach(2)'coriiplefe'setr of'Builtling Plan's plus a,L'ife Safety Page;{i}se#of Energy Farms.R-0=W Permit fbr new canstruction.
<br /> � Minim�m ten(10)working days after submittal date. Required ansite,Construction Plans,Stormwater Plans w!Silt Fence installed,
<br /> ;�,;'•� Sanitaryr Eacilitles S�s1 dumpster.,Si#e Work PermftfoF�all-new ptojects,Aii commerciai requ9rements must meet compiiance
<br /> �:'::SIGN't'ERMIT `Atfach�2"sets=of,Engineer'ed_Flans.��� ,�;- • ' `
<br /> � ) -_�_,
<br /> _- «...PROPERTY Sl'JR\/EY requlred_for,.aII,NEW construction.- .
<br /> :-Dir'.ectlons: ;,•;. �.. .� ...,, �. _
<br /> '� `Fill,out:application completely.
<br /> �` - Owner&Contractar s9gn back af�application,notarized
<br /> 3:":.:
<br /> If over;$2500;�a Notice:of:Commencement-ls required. (A/C upgrades over$75p0) _.
<br /> :;��:,:. ,w..-:.,.-< ��.�,,y
<br /> , AgenY{f6t ttie=ciintractbr)�ar°Powarof Attomey(for'ttie ovunecj would tie sameone with notarized letter from owner authorizing same
<br /> '��:OYER�:7HE COUNTER;PERM_I,TTING, (copy_af contract.required) � '� "� '� -
<br /> t;:Reroofs if sliingles, Sewers Servlce Upgrades A/C Fences(PlotlSurvey/Footage) _
<br /> ' ,.:�, ... ., -
<br /> �. Driveways-Not over3Caunter if on:public roadways..neeils ROW
<br /> z�.
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