|
813-780.0020 City of Zephyrhills Permit Application Fax 813aeo-oo2�
<br /> '-' ' '� - Building Depaetment
<br /> Date Reeelved . b -
<br /> ` - �.:::Phone'�Contact:forPermittln :;O/3 ��� - �d`3 , .
<br /> Owner's Name � Q ���C� � '�
<br /> Owner Phone Nlumbee $��- ?j3 _�
<br /> Owner's Address ��8� �/PD� �j�
<br /> , �e d�"'� �� �� Owner Phone!Number�
<br /> Fee Slmple TItleFiolder:Plame � � - - �
<br /> - Owner Phone Number
<br /> Fee Simple Titleholder,Addre�s � � -
<br /> JOBADDRESS ��� ` �I! �-�l�s / ��S
<br /> . LOT# �
<br /> suaowisiow - �aRCE�.i�* ��� ��.:��!;�
<br /> � ��. � D%9�
<br /> WORK PROPOSED (OB.T/UNED FROM.PROPERTYTAX NOTICE)
<br /> ._:.NEW CONSTR . ADD/ALT �� SIGN° 'Q [� DEMOLISH
<br /> _ . ., :INSTALL � „ REPAIR ,
<br /> PROPOSED?.U$E , 'Q SFR.� [] �COMM •.
<br /> TYPE OF CONSTRUCTION 1'• -'Q" �r'BLOCK f ` �� �OTHER
<br /> : :. [] FRAME ' .� "STEEL '[�
<br /> DESCRIPTIOA!OF WORK-' � ���a. H�`C e_�� � �
<br /> . . , � Ce'rr� D/l�eA��S � �'y� t�(. .1�
<br /> BUILDING SIZE�'' �� � �`SQ FOOTAGEj` "
<br /> , ..HEIGHT�
<br /> QBUILDING $ . .., , . ..... _ , , , .,
<br /> - , . VALUATION'OF'TOTAL-COySTRUCTION � - ` �
<br /> QELECTRICAL $ ' . , AMP SERVICE. . °.Q � �:pROGRESS ENERGY
<br /> � . - . . Q W.R.E:C.
<br /> ; OPLUMBING- $ - �
<br /> � �t,. „ � .
<br /> QMECHANICAL . $ ' '� ' VACOiq7'ION OF;MECNANICAL INSTACLATION.
<br /> � - � 90 6�� - � . . ,. ,:�,. : :, , . . ,
<br /> L�C,'AS �] ROOFING y0, ,� SPECIALTY�:�� . OTHER�,-... , -
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA
<br /> _ ,[�YES. ,NO
<br /> . .., . , .s �., . �.. ,. • ' --
<br /> . _ , ; z�-,. ,;r; _ -
<br /> BUILDER
<br /> SIGNATURE COMPANY.A.,,� _ .-,�-."�<�; . , . - . _
<br /> REGISTERED Y/ N .i��'�'�FEE CURREK.'
<br /> ;<, YYN' -
<br /> Address �� `�'� iL' _ .,::.;::.;, ��'.: :` . , _ . , , -
<br /> ' . ' ,'€�'-+:t � ,;Llcense}#�' .7 ; , ,
<br /> EL-ECTRICIAN;. - ,. . j , '... - _ '�v MPAN� `+ � , ._ :. ; ,,: �"._ . � ._
<br /> SIGNA7URE � •:}C:O Y '. - ; ;.�=;,p;�:�.��� _ �? . .. , _ _ _
<br /> R � - �REGISTERED ,
<br /> Y/ N F.EE.CURREK"�;� '�* :>`Y/'N
<br /> �ddress" ' ' . .,.. . - � � <,`, . . >,,;,,License.#F�'".. ,-,: �. �.
<br /> LUMBER � . . • . , ,C.OMPANY" . ', :.�.:; - : '_- • ,... .
<br /> IGNATURE` ;�, �' . , .. - ' -:REGIS.TERED , ,Y./�.N:s 1,:�,FEE-CURRE�:��. Y-/.N,- ,,
<br /> " , . .. - � . _ - x . -
<br /> 2a :`;? ' -- '
<br /> Address � , - 4': `;' , ' ,,: ;Gcense# ' . , - , .
<br /> �,. " _ _ _ , .. ,�. „ �y.ji'� - F
<br /> .. �i � .^ _ � � �' ... f'A. ,t.
<br /> ecw�icai:�� � ,. coMPi�t�r /fi2��v'fr�`,.!9l'.�(��.C�QS�t . �`�(G�
<br /> IGNATURE� ��� `� •• � j� t REGISTERED _ Y%,N ' FEE CURRE�,., -"Y/FN
<br /> , ,r, .��• , . _ _... . ...,-�,.,� . .- '
<br /> Address:" .� ����' !T�E� "` `.•�/7/L�'�it��.�5'rj�'/ � License#t ���`. �� O V,
<br /> . . , .. ,_ . .. .., .. . „ - . . ,. ,� _ �:, , „
<br /> ,. .. ,r,;,. •• ;,. - .. # _ , , ,.
<br /> THf�R �: ._ .r, . , __ _ � � , .,. , ;COIIAPANY:. . � ,� ..
<br /> GNATURE� , - , .. . .:: . . .. ... . � , a�� »:.:,�,:,, , . •, .. ....
<br /> "'�a� ��REGISTERED" Y/"I�F.:..�: !FEE�CURREi1':" Y/N
<br /> . _.. _ ,. � :�-., � . _, . . `s,� - .
<br /> � l�ddress.. .�'s >• • yf..��.- ,,E-:3:. . -<�,+_'s�=° - ;�'t. •,.rx ,. .r.,- ..,_.. ' _ , ;,L`'icense#�� �:s' . , , , • � �--
<br /> h<>.?�.at:^'r.: !.;-y.,-
<br /> rF t ._ .. .r. s�.Z .�;r.n, - .. ��s. , �::i..:,� ;:.�;f.�. - ,
<br /> ESIDENi1AL'�;,a,yAttagFi;(2)aPlottPlans;;(-2.)sets�of..'BnlldtngtPlans;�(1�)'s'et�of�Energy=For'rn"s;-'�R-O=W'P" V: , � , . -
<br /> errrmiCfornerv�co"nstructtori. ��G ti`•
<br /> �;- ;,,�f�,Minimum;Ren;(;1,O��,worl�tng�d�ys:after;'submitfal;date+��Requlrsdohsife;'ConstrucUon�Plans;.Stormwater�Planevid�SiltFence�installetl, � �
<br /> ' S�anifary Fadlfties,&:;1_d,dumpster-,;Site;.,W,ork,Permit;forr:sutidiyisionsAerge;projeots;`,�;,�;s.:�-� : -�i`_ �, - � ' •
<br /> - ,-:i:>., ..� ,,_.: -.:�.,.,.,� . ;,;���,,. . . - _ f....
<br /> OWIMfERC1AL Attach(3)�ooroplete�sets'of Building"Plans plus a Ufe Safe[y Page;(1)set of Energy Forms.R-O-VV Permitsfor neat'canstruction.� � .
<br /> Ndinimum ten(10p evorking days after submittal date. Required onsite,ConsUuctlon Pians,Stortnwrater Plans w/Silt Fence tnstalled, -
<br /> Sanitary Facilides&1 dumpster.Slte.Work Permlt for all new:proJects:-:All commerGal.requir.+�ments_must meet compliance, �� " �
<br /> IGN PERMIT AttacFi�(2)"§ets of�Enginee.r.edsP,lans:,;:.;:;^-��- , , .._ , � -.. . - �_ -
<br /> . � :.. .. ,:�
<br /> ""PROPERTY SURVEY reyuirad_fpr all,NEW corlstructlon._ -
<br /> �ections: ._,�,�.. � . ... : _ _ .
<br /> FIII out applicatlon completely.
<br /> Owner 8 Contractor slgn back.of appltcaUon,notarized
<br /> If over�500,a Notie�ofCommencament la requlred. (AIC upgrade�ovee 57500)
<br /> .,�..,.Ac-l.k:,r::,. "� .
<br /> ,.,d,•�,,., , -- . .
<br /> Agent(for the contracto�)or'Powe�of Attortiey(for tlie ownerj would be someone writh notarized letter from owner authorizing same
<br /> ER-THE:COUN•T,ER:P.:E - ,;��€q��.'.:I�RR,'Qf:�lAPlication�Qn�y);,;'-- . - _ �.. ,. : . �- .
<br /> roofs lf shingles Sewe ��,�i,ut;Sa�y�cp UA9.tad�;�(C ''�'='FHr`ic�s ,IoUSurvey/Footage) ��7���'A� ��;W�Y? .,„,,�„j:,,.,
<br /> r� ��':�J,�: . _ et:i�ei�Sr��s3� .;�tc1��������tc�" �i',:.:=�i.``'�'• -
<br /> --.. .,........._...� . �-ir `-'" i1!�%�''tii%�...�t���e_�:�:s�.�r-' �1� s�-e; - -- ' - �' " .. � ^`Y'� ' �'=
<br /> Drivewaym-Not over Cou ter If cn puhlic�oa�{wajrQ' need's;R�1�'i ;j;�.�� � � ��� �i ��a�,L.'�.:�.x; r,r sa J viv� �•�,'�1u� _;•`� �
<br /> ,�t: i�:Tc< i.iTf7{�d %�,,�; _ d �.^ y r '':
<br /> v.�;�' . •,F ;,:. : }� !i; ��r11�i`i rt:}i22ii^mrJJ '1��,%.i��':
<br /> ii?.,i; ",Eit:';r.:�p:fa,✓: :�i;:ri;fl G5D^t�A �.�„�,�.: . �•. .;, .
<br /> � i 1� .;�ze.�;t�tci�IrncrFl�;+,�.,:,,sr!,::v�,��;� J •R=,•,',.,��'��
<br /> ,. ''�,S"'�s'"2aa`�'.ye.:u'��'.,�y_.,�m,s'�: .�of�-��?;9'^u�.`'--.
<br /> �v`g�ra'�'��El���
<br />
|