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a��-�+ao-oozo City of Zephyrhills Permit Application Fax 813asaoa2�
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<br /> ' „ Buftding Deparbrtent _ ,
<br /> Date Received gf ���_ ���..
<br /> � Fhone Contact far�Permtttin
<br /> Owner's Name ,�—�7l�� `�T�' ' Owner Phone Num6er 4 ��� /��`� �7�
<br /> Owner's Address � � �a��o�.-. /�/i�' � , Owner Phone Number � �
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<br />� Fee Simple Tltleholder.Name � � � Owner Phane Number � �
<br /> Fee Simple Titleholder Address
<br />�, J08 ACIDRESS �Gl 74�� v�`��'"!"' `��`� !/ G' �. �� � � LOT# �__�
<br /> i SilBDIVISiON � PARCEL ID# �� �4�,. ���� ���'� ����
<br />� . , (OBTAINEO FROM PROPERTI!TAX NOTICE)
<br /> WORK F�ROPC}SER _.NEW'CONSTR . ADDIA�T [� 81GN Q Q DEMQI.tSH
<br /> �•�e, INSTALL � REPAIR - '
<br /> PROPiUSEDiUSE � Q SFR- Q CAMM C,� C?THER
<br /> TYPE OF CONSTRUC'170N •� Q�' � BLOCK " Q FRANIE � ,STEEL �Q
<br /> pE3CRiPT10N OF WORK � ��� a �f� �¢�"f} e ` `jZC-� � �� v/V�'/V/'� +rx ��
<br /> BtlILDING Sl2E"�� �'SQ FOOTAGE ' . ,HEIGHT;�����
<br /> QBU{t.DtNG $ ' � � . �
<br /> ��� VAIUATtOtd'.OF`l'OT'Al COFISTRUCI'IOiU
<br /> L .J
<br />� QELECTRICA4. �$ ��� ' � AMP SERVICE Q 'PRCOGRESS ENERGY Q W:R.E.C.
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<br />'� QPLUMBING .$ `
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<br /> �, C]MECNANtCAL � j� 1�P Q VALUATION OFi MEGNRNiCAI.INSTALIATEQN
<br /> li QGA3 Q ROQFING .Q SPECiAi.TY � OTHER
<br /> FINISHED FLOOR ELEVATIONS �� FLOOD xQNE AREA QYES. NO
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<br /> 1 8U1E.DkR CQ14�I�A�+lY - .
<br /> � SIGNATURE REGISTERED Y/ N FEE CURREA Y/N
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<br /> I� Address ` - Ltcense#'� �
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<br /> � E�ECTE2lGIM1: _ , -=GOMPANY' � - ` � -
<br /> I $IGNATUFZE � REGISTERED Y/ N FEE'CURREM'' ` "Y/N
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<br /> Addre�'s � � _, Ucanset#.,$ , . : �
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<br /> RLUMBER ' � COMP1}?�!Y �- _ ,- .
<br /> � SIGNA7URE' � � " ' , .REGI3T,ERED Y,./•N. : �,_rFEE CURRE� , '� Y_•/N: �' '
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<br /> AddreSS ' LtCe11S8#�t. .. .. •:- , : w�.
<br /> MECHANICAI:� ` -` - � �,p�,eJL , . COMPIWY S t'4���1J{�: `t--�/ �Nc
<br /> StGNATURE� '`^G�� � REGIS7ERED.,, Y.:/ N. , FEE CURRE�. X./•N -
<br /> Addre�s'':. ;'��'�}'j !`7"�l'e11� � ' Licpnss#���`��-� �����
<br /> OTHER .` _ , ' - . ' `;CQNIPANY
<br /> SIGNATURE'� �:% ' � � -• �' ��' ' ' " � �'REGISTERED Y/ N,.- FEE CURRE� . Y 7 N.
<br /> Addre� � `ri:� _ - �.Y« . , �`} �k �tC;e�tt89#'� � � ��
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<br /> RESIDEN'iEAt;,"� =Attacti"�{2).Ptot�.Plan`s;,(2}sets:of�8utttling;Ptaits;�{1)sef of�Energy�Foiins;.R=0-W'Pernslf tar new constcucti,on, •.� � .�
<br /> ,,;,��:Mintmum;ten�(�1.0)*workingydays:a#ter„submitfal date::Requl�ed onsite;:Constiucdon Pians;'$tortnwater`pians�wi SIk�Fence inst�lied,
<br /> �� Sanita''ryFaciltUes;&:;1:dumpste,r,�Site•Worlc;Pertnit#qr;subdivlsionsnargepraJects -__';,_- }� � ` � `
<br /> COMMEitC1AL Aftach{3)`C;omplete sets'of'Butldi'sg Plaiis�ptus�a'I.tfe S'af�s#y'Page;{1}set of Energy Forms.R-t}-W Pennl#for new canstru�an. -
<br /> Minimum ten(10)working deys after submltMal dake. Requtred onsite,CanstrucHon Plans,Stormwater Plans w/Silt Fence installed,
<br /> Sanitary Facilitles&1 dumpster.Site Work Pertnit for all new.proJ�icts..All commercial requlrements_must meet campllance
<br /> SlGNPERMIT AttacFi{2)"setsof'Engiiieet�iii4Plans.,�-.•,•:��� .���,:__-.-� . ' . -
<br /> """PROPERTY SURVE1f required for all NE_.W aanstruction.. _ . .
<br /> Dlrei:tions: . �:. , .
<br /> Ffll out applicadon completely.
<br /> Owner&Contractar sign back of appl[catlon,notarized '
<br /> If aver�40,a NoNce of Corr�mencement ia requ�rad. (AlC upgrades over;67500) •.
<br /> '* Agent'(for the ainbractor)�'o�Pou�er,�f qtt'ariiey„(fo�tFie ovuner)�would be'someone with-notarized letter from,ow�er,autl�orizing,sar�e�.
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<br /> K3VER'THE GQUNTER PBRMiTTtNE#-.._-- .(Fr`ont�af-Appllcation°Only)-- M,.��..�"�tt '; ,.:„ �.. ;^��?�Y� , "t , �
<br /> Reroofsifshingles Sewers ServiceUpgrades,A/C �, ,.,Fen�s(PI,oUS�rvey/Footage) �' .�.,.��,' .� .'�'� � -���" •«;o�: � ` �_ �"
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<br /> }{1 !.,: ,."-iz'��`, I.-�' � ,�P". - ... . , ..;t:�•�tF�', .. :F '".x
<br /> brivswaya-Not cver CouMer if an publ}a roadwajis..rieeds ROW;; ��?3;,r�1. '� 'fE� i�"' . ., , r�:j . �%,f,`,' ''�
<br /> .� � ':.q:.si.Y3.-•�1'91�k�ti cC�... �i�...:.�'',�,,^` �r 4A�».�»n.;..;.,�;^.`.��._,......... . . '+_ ..uµ ',c�—�t.� t5
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