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813-780-0020 City of Zephyrhills Permit Application FeX-s�3aeo-oo2�
<br /> Building Department .
<br /> Date Recelved • _ . . -
<br /> - �;Phone:Contact for�Permittln -.' °
<br /> Owner's Plame �"b�''���. �6�tlt-�L� Own�r Phone Number ��3" �� ��'�'4��
<br /> Ownar's Address � �oZ��. �,r� ���� �,�, �_ Oweer Phone Number�•
<br /> , . .
<br /> Fee Slmple Tltleholder-Nam� � Owrner Phoee Number �
<br /> Fee Simple Titleholder Addresa
<br /> JOB ADDRESS ��oZ�L. p,(� tilS. LOT# �
<br /> SUBDIVISIOW P.ARCEL ID# � 4 �
<br /> - , � � • , _ ,; (OB,TAINED�F.ROM PROPERTY,TAX NOTICE)
<br /> WORK PROPOS�D NEW'CONSTR-" ' ADD/ALl' � Q� SIGN `Q • Q DEAAOLISH
<br /> .. ,.,B_- � INSTALL ��• :;--REPiAIR •- � �
<br /> PROPOSED:USE . , SFR�- � � COMIIA �Q �OTHER "'� ' " �
<br /> TYPE OF CONSTRUCTION � g� ' BLOCK ' Q FRqME Q ;STEEL Q
<br /> �Y -
<br /> DESCRIPTiON OF WORK• � " � t e1'�.� c�� Sa� �ocsa�'�"D�
<br /> BUILDING�SIZE�` • �� � � SG FOOTAGE`' 2 _:HEIGHT��. � .
<br /> �:. -
<br /> QBUILDING $ ' �- . . � ,. �� .. -
<br /> , VALUATIOiV'"OF�TO'1'AL CONS7RUCTION
<br /> QELECTRICAL. $ " - AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
<br /> QP,LUMBING- '$ �� . � �
<br /> - �� 6
<br /> [�MECHANIGAL $ D VALUATION OF;MECHANICAL INSTACkATION
<br /> .� :..
<br /> QGi4S Q ROOFING Q SPECIAL7'Y Q OTHER l2 ??�
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES. NO
<br /> BUILDER COMPANY'� °' • •
<br /> SIGNATURE REGISTERED Y/ N 'FEE CURRE� Y/N -
<br /> Addre�s ' � •License#: '� '
<br /> , . � � .. .
<br /> ELECTRICIAN;;,,<,.. . , ',. ,.'COINPANY - . , . . - - .
<br /> SIGNATURE � REGISTEREO Y/ N �E'cu�n4� `�-YGN` °
<br /> Fi;.�� ., _ ' - , ,. " .. _ p
<br /> Hddeess' � , _. : Licenser#y,_' -
<br /> PLUMBER ' " COMPANY . ., �• ='
<br /> SIGNATURE'`'�� '�* � � f.REGISTERED, , Y./F N.= ;FEE GURFtE� - - .�Y/N �
<br /> Addre�s :r ,: :LIC9nSe#� � �
<br /> .. . -x._t:
<br /> ;, �i: ... - _ - t -' ,
<br /> MECHANICAL�, .. . . - �., � . . COMP.ANY, ;ie � c,. �+�,n�. � a�• ,�C,,
<br /> SIGNATURE- � • ' � � �'� � r��Ss7EReo',. . Y./ N ' �E,cuwtEn Y./N ,
<br /> - �:ri .. . , . .
<br /> Address"`..�" '.s' ,, ,. _....-.. ,, ..: �, , ,. � �� - .., , . . - LicenS.e#�. C�\�`l.rJ � '
<br /> � � -.. , , . ,-, :��,,.: _
<br /> ;ii, . . ,-., _ .� _ ,._ , • ` , . ,
<br /> OTHER '�. .;r�;; .. . r.,, : :. ., - ,_., - -, 4 ;. �.:=4COMP��NY��R � ` • �_ . -
<br /> SIGNATURE' .:. - w::�_.:_• _.. � '.,.,. � �� F... ,
<br /> 'rs� - 'REGI$TERED � Y/ N;.: FEE CURRE� � Y/N.
<br /> x; . _. . ,. . , - . ..
<br /> .;i:;'.�. .� , .., .,_ -.. . • -
<br /> �dfA�S :iF;;r^::�"��• �"�4�: �,��r"'''i. F,r.. -'`' ` � „ . , - ' "L�CAf1$9'#'' - , • . �
<br /> T�' �,n y�?,�u..;.;�,.. �� �.,1.4�,��r..»x. ._ r<.r� .,�, L'�" ' . . .. . .
<br /> RE$IDENTI�a:;�;A1�cFi"(2);flotiPlaris;a(2)sets�of�9uildirig(Pla`n's;(1)setof;En'ergy.`Fortns;J2=0�1N�Pem%if f6r new construcUon,
<br /> � ;:;�:Minimumpten�(10)worl�ingydajis�after;subinlltal date:i:Requirsd onsite;:Co`natiuctlon£Plans;�-Stortnwate�`Plans�w'/Silt'Fence Instelled,
<br /> �'''�V�San tary Facllltles_,r&;:1f,dumpster�Slte;Worfc?PeRrlit;#O�;SUI��IiV,ISI01fs%18rg8fpP,GJeC1s;::._�i;';�,: ,� �•• , . , ___
<br /> COfVIME1ZClr'� rifeach(3j�complete sets`of�Building Plans plus a Gfe Sefety Page;(1)set of Eiiergyi Forms.R O W Pertnit for neW construcdon.. �
<br /> Minimum ten(10)woticing days after submittal date. Required onsite,ConstrucUon Plans,Stortnwater Plans w/Silt Fence installed,
<br /> Sanitary Facllides&1 dumpster.Site Work Permit for all_newiprojects::All commercial�equl[emen�must meet compliance ' �
<br /> ,.�SIGN PERMIT Attacfi""(2):sets ofEngfn�eied�Plans:�,�•;:r,��-w`- �;•�:��ti==-: - ' -�
<br /> ••"PROPERTY SURVEY reguired for ail fdEW construc,Uon..�.. _ �- .
<br /> ..Dir�ctlon�: . -k,.9.;�- ..,. ,� „ . . . ., , ..
<br /> FIII out applicatlon ccmplately.
<br /> �wner 8�Contractor slgn back of applicatlon,notarized �
<br /> If over y2500,a Notice,of Commencement is requleed. (AIC u�grades over$T500) -
<br /> r:,.-z;�.�.-s;;•� -
<br /> " F�qent(for the contrac�or)'or`Power'of Attomey(fo�tFie owner)would be�someone'with notarized letter from owner authorizing saene
<br /> DVER'THE COUNTER:PERMITIING.- �--,�•(Front�of•ApplicaUon•Only)�-- •�- -� "' 4 � �
<br /> Reroofs if shingles Sawers Service Upgrades AJC Fences(Plot/Survey/Footage)
<br /> Briv�waya-Not over Counter If on public roadway's:.needs ROW� �
<br /> .,y,%
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