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<br /> 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
<br /> Building Departrnent
<br /> Date Recetved w � • ��� � Phone-Contact�for�Permittin � -
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<br /> Owner's Name 9� / L ��Zt�� Owner Phone Number O /, �i,�a l/S� .
<br /> Owner's Addrass ���, �i' � Owner Phone Number
<br /> Fee Simple Tltleholder Naene � Owner Phone Number �
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<br /> Fee Simple Titleholder Addresa
<br /> JOB ADDRESS � LOT# �
<br /> SUBDIVISION 1' U' P,ARCEL ID# C� O �2 0 O D o s� p
<br /> , (OBTAINED FROM PROPERTY TAX NOTICE)
<br /> WORK PROPOSED _NEW CONSTR ADD/ALT Q SIGN -Q Q DEMOLISH
<br /> �.8: INSTALL B REPAIR
<br /> PROPOSED.USE � Q SFR Q 'COMM [�] OTHER
<br /> TYPE OF CONSTRUCTION Q ' BLOCK " Q FRAME Q STEEL Q�
<br /> DESCRIPTION OF WORK � C �t� ,�j`- • /j� � � ��
<br /> BUILDING SIZE SQ�FOOTAGE C� , HEIGHT � � � ����
<br /> QBUILDING $ VALUATION�OF�1'OTALCONST`RUCTION
<br /> QEL'ECTRICAL $ - AMP SERVICE Q PROGRESS ENERGY Q "W:R.E.C.
<br /> QPLUMBING $ � �
<br /> � l 8� /
<br /> LlQJMECHANICAL $ '���, VALUATION OF;MECHANICAL INSTALLATION
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<br /> QC�,AS Q ROOFING Q SPECIAL7Y Q OTHER
<br /> FIfVISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES. �NO
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<br /> — BllILD�R - - -- COiY7PAW11(:, . - - -- --- - - - = - -_ - - - —
<br /> SIGNATURE REGISTERED Y/ N . FEE CURRE� Y/N '
<br /> Addre�� -- f ^� License#'� �
<br /> ELECTRICIAN.. � COMPANY�� , .�:' :': � ' -. � . � .
<br /> SIGNATURE w' REGISTERED Y/ N FEE CURRE� `'Y/N .
<br /> Address � _, ;;. License,#_' -
<br /> PLUMBER '� � COMP.ANY �.�,, � �,
<br /> SIGNATURE ' ` , REGISTERED Y/..N� =,.�. FEE CURRE� Y/N:.• : 4
<br /> Address � _Licanse,#`., • . . �. -
<br /> MECHANICAL� ' ' / COMPANY ' f ' '�� _ .
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<br /> SIGNATURE- � REGIS7ERED. N . �� FEECURRE�- . .Y/sN:
<br /> i � . . .. . -. .
<br /> ` _, � / .. • ; : . -
<br /> Addreas"_=�� �/ � ,License#�
<br /> OTHER " �- 'COMPANY �
<br /> SIGN�►TURE -,. - - - - ' � " ' REGISTERED Y/ N.. J FEE CURRE� Y/N
<br /> Addre� -�� • � � � ` License#'
<br /> RESIDENTIAL'_,� �Attacfi"(2).;Plot+.Plans;(2)sets.of=Building"Plans;'(1)sef of.Energy�Foims;R=0-1N�Perinit fqi new construction, _
<br /> - -,.Minimum;ten;(1.0);working;days�-after"submittal-date.�sRequlred onstte;_Construcdon'Blans;'Stortnwater�Plans w%SIIt�Fence installed,
<br /> >_._„ - ,, ,, _r_,.... , .
<br /> � Sanitary Facilitles�&�;1,�dumpster;Site•Wo�Ic:P,,,ertnif#ar sutidivisionsAarge projects:.,.:� :;: ' `'
<br /> COMMERCIAL Attach(3)complste�sefs of Bullding Plans plus a�Life Safeiji Page;(1)set of Energy Forms.R-O-W Perm(t for new construcUon.
<br /> � � Minimum ten(10)working days after submittal date. Required onsite,ConstrucUon Plans,Stortnwater Plans w/Silt Fence installed,
<br /> Sanitary FadliUes 81 dumpster.Site Work Permit for all new,�proJects:.All commerGal requlrements.must meet compllance
<br /> SIGN PERMIT AttacFi"(2)sets of Englneered:Plans, - r� ' � �... . •
<br /> "'•PROPERI'1'SURVEY required for all NEW construction.. _ ,
<br /> Dlrectlons: - � � . • '
<br /> Fill out applicaUon completely.
<br /> Owner 8 Contractor slgn back of appltcadon,notarized
<br /> If over�2500,a Notice of Commencement Is requlrad. (A!C upgrade�over 57500)
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<br /> " Agent(for Ute�oontractor)'or Power of'Attoiney(for Uie owner)would be someone with notarized letter from owner authorizin�same
<br /> �VER THE COUNTER PERMITTING -- •(Front of ApplicatiomOnly)� ' � �
<br /> Reroofs If shingles Sewers Servlce Upgrades A/C Fences(PIoUSurvey/Footage)
<br /> Drivewaya-Not over Counter if on public roadways..iieed's ROW �
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