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<br /> 813•�ao-oo�o City af Zephyrhills Permit Application Fax 813-780-0021
<br /> _ " Building Depathneni ,
<br /> Date Recelved
<br /> . �j � .�' f � Phane�Contact for Permitftn ` � .�v2 �,� �`
<br /> 4wner's Name � t3 /"'f.�t�T'F C�'t- Owner�hane Nnmber �fc�' ��� " ld�..�
<br /> Owner's Address �/`� �"s�-- , - Ownar Phone Number �— �
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<br /> Fee Simple Tltleliolder.Name ' , _,,,, ,, ,,,w Owner Phone Nuinber ' �
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<br /> Fee Simple Titleholder Address
<br /> JOB ADDRESS Lt�YLrC,r LOT# C�
<br /> SUBDtViSION • �� � PARCEL ID# /`°� � � �/ � CO 0✓O• S 00 • /6 c�
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<br /> , , (OBTAINED F.ROM PROPERTY,TA%NOTICE)
<br />� WORKPRQPOSED. taEwcaasr� ADDlALT [�� SiGN� '0 Q DEMoi.iSH
<br /> �.e, , INSTALL 8 ; REPAIR
<br />� PROFOSEQ�t1$E � Q SFR [� COMM [� 'OTFiER - -
<br /> TYPH OF CONSTRUC710N " C] BLOCK ' [� FRAME [[�� :STEEL Q
<br /> DESCRIPTION OF WORK - �,'9 � / I`�%1 ��'� � ��-�G- � ��� �
<br />� �UtLDitdG'SIZE � � SQ FOOTAGE � ..HEtGH�T�
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<br />� �����'d»�' � VALUATiO1V'.�JF`l`b'1'AL"CONST12l"1CTiON�� " '
<br /> QECECTRIGRI. � �'� AMP SERVICE Q 'PROGRESS EtVERGY Q W:R.E.C.
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<br /> QPLUMStNG� �$ �
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<br /> �VIECHANIGRL (�„�n����' VA�UATION OF MECNRNtCAI INSTALIATIt)N
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<br /> C]c�as o �oo��N� o : SPE�1��n o oT�sEe�
<br /> FINISHED FLCIOR ELEVATIONS ��� FI.00D ZONE AREA [�YES NO _
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<br /> ---BEFECDER _ - _ --- - - - - COMPA4tY'� ,- __ __ _ _ _^___ , .
<br /> SIGNATURE REGISTERED Y/ N FEE CORREA Y/N'� .
<br /> Address - - _ � ,- :�>. �. � Gcense# � `. � �
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<br /> EIECi'RICIAN; ' .'COMPANY':` `� . � , , �
<br /> SIGNATURE � REGISTERED Y/ N �Ee cUrtaen=' ' ' �=•Y/N�. `
<br /> ' Addre�s � . ,. A� .;��' ..-.YL'License.#,I"., �. � . �
<br /> ; PLUMBEl� ° - . . COMt?ANY , ... v
<br /> SIGNATURE� ` REGISTERED Y./.,Nr wFEE CURRE� Y/N: - < �
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<br /> , Address � , , _License�# � • ��:
<br /> MECHANIGAt:` ` ' � COMPANY ��f � r .
<br /> SIGNATURE (iG� ��Zi '"' �'�. � REGIS7ERED , ..N . � PEECURRE�-: Y, N�
<br /> Address x':• � �; G� ,�C.)� . � �.. License# ��r d +'���� ,
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<br /> �5��� � - ,. � ". ` ' � 4.{�.,�M��Y , �
<br /> SIGNATURE^ •� � ' � � ' ' REGISTERED " Y/ N..,� 'FEE CURFtE� Y/N
<br /> Atldre�8 �� ,,':> _.. . _ . - - , ` CiCB`nse#`� � �
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<br /> RESt0EN11Al;,';:::A�eti:{2)„Plot�.Platis;�{2}sets:o�:Btaitiling`'Plaiis;('t)'sefof Energy�Fo'rins;F2=0=1N�Permit far`new ciii�struc�on, _
<br /> �. �LLY;�Minimumaten�_(�1,0);,,working;dajrs�:afte�_subriitftal'd'ate.::Required onsite;:Constnictlon Plans;Stortnwater'Plans-wI SilfFence installed,
<br /> Sanitary FaciliUes&7 dumpster,�Site•WorlciPermlt#pr.sutidiWsionsnarge:projects,,=�_,-���;�<<. ' ' � �
<br /> COMMERCiAL Attach(3)cbssiplete sefs of Buildiog�Plans'plas a�Ufe Safety Page;{1}sat of Energy Forms.R-Q W Permit far neW construc�o�.
<br /> - � Minimum ten(10)working days afker submittal date. Required onsite,ConstrucNon Plans,Stormwater Plans w/Silt Fence installed,
<br /> Sanitary Facilifles�8�i dumpster.Stte work Parmlt for al!ne+iv,projects..All c�mmercla4 requirements,must meet caampflance '
<br /> SlGN PERl�IT Attacii{2j'sets of Erigineer�drPlans::. --,� ': _. �_t _
<br /> '••"PROP�RTY SURVEY'reguired,for all NEW_constructlon.., _ -
<br /> Otrectlons: . , .- , i
<br /> Fill out applicatlon completely.
<br /> Owner&Confractor stgn bactc ot apptfcatlon,natarized
<br /> If over 52500,a Notice of Commenceme�tt ls requlred. (A/G upgradea over ST500) _ �
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<br /> " Agent(for the i:ontractor)'or Power of'Atfor�iiey(far ttie ownerj would be someone with notarized letter from owner authorizing same
<br /> DVER THE CUUNTER.PERM{TTiHt3 -��(Front of•Application�Oniy} ' - ',
<br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage) .
<br /> Drivewaya-Not over Counter if on pubiic roadways..needs ROW
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