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813-780-0020 �'
<br /> City of Z�phyfiilis Permit Applic�tion Fex-813-780-QQ21 ,
<br /> Buitding Departrnent _
<br /> '�-
<br /> nr , . "
<br /> Date Recelved , � ,
<br /> � � - ;,Phone��cnfact�tor�Pernitttln =
<br /> Oweer's Name � C� Owner Phon�Nnrnh�r
<br /> Owner's Addreas �� � � �Owner Phone Numb�r � �
<br /> Fee Slmple Titleholder'Nam� �C%�' �PiL�Q �, �� Owrner Phone Number "�� � �
<br /> Fee Stmple Tltlehold�r Address
<br />� JOB At3DRESS � �. - G LOT# ��
<br /> II SUBDIVIS101V C— P!ARCEL,I�# � � . , °
<br /> I _� ..
<br /> - „ , t ` ., (OBTAINED F.ROIVI PROPERTYTAX NOTICE)
<br />� WORK PROPOSED: �.�.IVEW CON5TR''- ADDlAt:T �[� SIGN Q• " [� DEMOkISH
<br />, . ,. ���.� INSTAI:L. 8 : �-REPAIR' •�• - �
<br /> PROPQSED>IISE - , f0 SFR- [� CQMM ..[� xOTHER' ' ' ,
<br /> I TYPE OF CON3TRUGTION U ' BLOCK ' FRAME
<br />� Q. [� ;� ,`STEEC . C]
<br /> , �; .
<br />' DESG1t1i�710W OF WORK' , —' cs ` ,�r. T.
<br /> Btl1l.DIAlG`SIZE`�'� - " �'SCl�FOC1TAGE�: „ ._�itE1GHT .��
<br /> , �rk ':e, . - . .
<br /> ��"�»'����' � " ) �,� VALC1ATtON'OF�TC)TAl:"CONSTF2l`iC`fiON �
<br /> , t L--C1 v- ,
<br /> QEl.EGTRIGAI. $ " AMP SERVtCE � �PEtt>GF�SS ENEFtGY Q W.R.E.C.
<br /> OPLUM8ING $ �- �-
<br /> .� � � ..
<br /> [�MEGHANIGAL $ YALUATION OF;MEGHlWICAi..lNSTRCLATIQIV-
<br /> � �'. , .
<br /> �,]GAS , Q R�QFINQ Q SPEGIA�'TX [�� QTH£R, . �
<br /> FINISHED FLOOR ELEVATIONS (��� FLOOD ZONE AREA QYES. NO
<br /> L
<br /> . , . ;
<br /> SUil.t1ER � ' a CCiMPi4NYr, : �� ' ,
<br /> SIGNATUR � REGIS7ERED Y/ N FEE CURRE� Y/N�. �
<br /> Addre�s ' . License# { - ' �
<br /> E�EGTRICIAN; .r, • , ° r:;,GOMP�WY" - ` � ' - �
<br /> SIGNATURE� �' REGISTERED Y 1 N �CURftE�° •- ��Y/N` '" '
<br /> Actdee�'s' , _ , - ` ' . w �icanse:#�,�, - ' �
<br /> pLUMB�R':; . ' ' ,G�iVIpAEIY • - . ..�r ,_. . : ;.,
<br /> SIGNA7URE''�' '{ " - r' ` ' , ,5 REOISTERED, , YI,.N• .FEE•CURRE� � 'Y./N. �
<br /> Address . , � ., , t[cense..#`(� .,�... : ` � ' �
<br /> .. , . :��__-�� -
<br /> �:,. � , : �. .r . _
<br /> BIFECHANICAL`" "' ;i" , - � ' '" . - `� `, ,CCiMP�1N1C, � . . .. .,;-:- _ '.
<br /> SIGNATURE� ��Y` •• ' '" '" � " � REGISTERED , Y,/.N .�;,FEECURRED:�- Y./rN'
<br /> Addrs�s'�'�w��{ .,. , ..�� .r`. .� _ < , ,. F .. . � ^ s� i . license#, �
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<br /> ;;s; �:- ... . . .. ._ .� _ , - _ �
<br /> _ :� .� ;�: -� _ � ';. ���: .;;� - < . , .,::, - , .
<br /> 03NER �,• :�, . .� , ., ;s GOMP�ANY . . __:. .. _ -
<br /> StGNATURE" ..':r• r{,' '-�`<"- �=> ., _ . , ,� " �REGI$7ERED�, y •Y/ N.,..: ` ,FEE CURRE� Y�/N.
<br /> �t�PBSS„ +fe`b 1.. `'t.'i;�'".`t".u:� '.k`;x. ._ .'.�� ;r=" ,--�yf i:' . ., � . " , ' -'�C811S0'�'�� �
<br /> � -�. � � „�, .M1k,:� p.: xo �'�':a.fu..,,�. t�-: f.' •�, . 5�. .._ `�•' . ::1� i ' , � •
<br /> RESIDENi1Ai:,�;:;'°,AttactiC(2}4PlotiPian"s;,:�2}"set"s:o#=$ullding�F'taii's;{'f}sefof=Ener+gyr:�ortns;R"0=W.Reiiriif for new t�sistractEon, _
<br /> _-�;.��,3 Minimums.ten�(10);,woriting�days�afte�,,s`_ubi��tEal'daCe:�Requtred onsite;;Constru�fion'Plans;Stor'mwater Pians•wi!SIItrFence installed,
<br /> ~„ SaniteryFaGlttles�&;11dumpster,�Site WorlcyPermit�o��r;sutidivislonsnerge;proleots;;;.=;y r�._.•. :; , . � :��, " : .��'y ' u
<br /> COMMERCIAI. Attas�{3}�i�inplete sets`'of Bu1C�titg Plaris'plus a.l:ife Safetyr Page;{'1}set of Eiiergy Farms.R 0-111t Petml#fot aev�r construc#ion. �
<br /> Minimum ten(10)working deys a�ker submlttal date. Requtred onsite,CansUucNon Plans,Stormwater Plans w/Sllt Fence installed,
<br /> Sanitary Facilitles&1 dumpste�.Sita Work Permit.forrall,new�pro�Ject's::i411 commercial_teguirements_must meet eompllance
<br /> ;SEGN PERMIY AtRadi'{2)sets af�Eirigirieer"e",d;F,lans:�_ -t: ,�.�x��,: - - .
<br /> ' . "•""PROPERTY SURVEY requlred for all NEW constructlan.., _ _ _ -. -�• -
<br /> . ��7�.i'�Olt�: � :+w.,�;r,,,=..�,,. ' ' .
<br /> Fill out applfcatlon completely.
<br /> � Clwner&CantracMr sign back ot appiEca@on,nata�ized '
<br /> if aver�t500,a NaNce of,Comroencement is requtred. {AtC upgrades ovar;7500) .
<br /> 'S':.:;;�r:Y�+��„�iS r.'.:\";
<br /> '• ent for tNe conVactoc 'cir'Powe�of Attame for the pwner would be'�someone viiith notarized letter finm owner autho�izing same
<br /> �'�9 ( ) y_�.._ _.n_.. ) ,
<br /> QVER.'tME�C01lN'f,ER<PERMiT7'!F!G_..--..--(Front-of-Appticatlon-Oniy)•_.._.._ � ��
<br /> Reroofs If shingles Sewers Service Upgrades A/C Fences(PlodSurvey/Footage)
<br /> • Grivewaya-PMt aver Cflunter if on pubtic roadways:.need"s ROW` � '
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