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<br /> _ 813a8o-oo�o City of Zephyrhills Permit Application Fax-813-780-Q021
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<br /> Butlding Qepartment .
<br /> Daie Rec�l ed � . • _ - . :�:Rhons.=Ccntact�tor�P.ermitttn , ,
<br /> Owner'�Nama 'i'�� � , Ownar Phons Number
<br /> Owner's Addre�s � � ' ' Ornrn�r.Phone"Nuntber � �
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<br /> Fee Slmple Tltleh'older.Nam� � � � Owrner Phaoe�Wumber '�� �
<br /> Fee Simpl�Titleholder�lddre�s
<br /> Ja8 RDDRE3$ �.7!� CU� C� � LOT� ��
<br /> SUBDIVtSt0�1 �� . � ° P.ARCEi.I�# " '
<br /> • - •• i � (O.B,TAIPIED�FROINPROPERTYTAXNOTICE) �
<br /> wo�K�Roeos�a� c��nr rn�-� � : � ,�nl,�:�r 0� �si�� °C] �� "CQ oE�a�,tsK
<br /> , ,�e,- ��.INSTAI.L> � . .REP�11R •:� .
<br /> PROPQSEDzUSE . , ,CJ SFR [� COMM , .�,� �QTHER� '� ` .
<br /> TYPE OF CQNSTRUGTION < Q' ' BLOCK ' Q FRAME ' .Q STEEC. Q -
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<br />� �E�CRIt�TiON:OF WORK � I� I tG, , - . " _ I
<br /> Btl1�DING;BlZE.' • � .� ;3Q;FOOTAGE�:,.. . . ..,iiE1GFIT���r�
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<br /> QBUii.t)ING $ VAIUATtON�tSF�Tt}TA�"CON3`CRlJCf1aN ' � ~ !
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<br /> �CTRIG�L. $ ' �}' - AMP SERVICE `�PFtOGC2E5S ENERGY Q W.R:E.C,
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<br /> QPl.UMSlNG ;$ � °-
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<br /> OMECHANI6A! $ ' 1lALUATlOIV l7F MECHANICAI.lN3TALI:+AT1£)N_ I
<br /> QGAS Q ROOFItVG .Q a�FEC1ALTY � OtHER �
<br /> FINISHED FLOOR ELEVATIQNS �_____�! FLOOD ZONE AREA QYEB. NO
<br /> �WLDER � _ � COIUtPAHY` _._- .
<br /> SIGtdATURE REGISTEREb Y/ N FEE C19RRE� Y/N ` '
<br /> Address ' � , �t�cense#: '
<br /> E�.�cr��c��- ,., : �-��'.�.._.._�� -� ° ;;co�p�wr� �e�tc �G a.. �'. � ��
<br /> SIGNpTURE ���'���'t� REGISTERED Y/ N FEE 6URREK`'` -��Y!N�
<br /> Ad�res� tP i $� � � . _. . Cicenset#�:=��G�1�.J.�to � ` �
<br /> FLUNiBER"' � � .COMFANY ' -.,, - ,
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<br /> SIGNATURE"Y�� 9"' • ' _• " _ ,�..REf31S.TERED., , Y,/,.,N, ;FEECURREA � , - Y:/N �
<br /> /ld{lr88$ � s . � .iJCBnSBr#'*r,f•.'. . . -... . �' ^
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<br /> � MEGHRPIICAt:. ; ,'�•:. . -- , . " _. ' ` �OlVIPANY .' .. .. _ ..::�.,., „ . _
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<br /> SIGNATURE�� •r " � � � ` ` �' " RExG13TERED Y./ N FEE CURRE�,., Y hN.
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<br /> Addre�s�:�:., ,;z r � .�. ..:� • ;�.. -' - . ..�,` . � �,�5
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<br /> OTHEIZ .. ='�.�. ,=..L �,: . � .a'>' ' • `. > ,.,�.. _ .. . -
<br /> ;COlU���Aidal " , " �
<br /> 4�e.'.t^ ,,.o .i.�. :r'':. ��."'�"� - �
<br /> SIGNATURE" .r;�` ;ta;ar�:, .-.'•�,._ _�„ ai . ., . ,. . .• _REGI$7ERED Y/ N:.; FEECURRE� lf/N.
<br /> - - .:.:;... _ F,:_ . , ,� ;. . _
<br /> A��f$�4y ;'§7%+��t".}t.> w:'�i�.-tr-,.. .1.�._�It•.` ' �Y-5 :�f�. ._���.�c.t„'B.r`iu.s,. � . .���(�S$Sr"� - .. ��
<br /> � " '� ! ` 3 S' kYq�;xrt,,,`r•��+: ' t`y"er . . , ._. . :. ._". -'rJY .
<br /> �RESIDEN ,`Al1�c.��:i 2}�P1ot;Plan's;a.(2�}sets:afi�UIItII(1$1'PI8ti8;'('1)s'etiofsEnergyrx�arrns.R=O=W=Perrriif far new:construottori, '. _
<br /> �`~;5 i..! m 'I,-�."..yr„v'.r�'e.i "p i.,fi - � ^, . . _ . ��I . .'
<br /> �•t�_;_�at�,Minimum;#enr(b10);�uvorkiqg�ilay,'s2afterasutiinifta�Fdete.�:Requtr'edonsite;GonstnicN`ori:Plansr'Stormvirater;Plans-w/SI(tFenceirista{ied, _
<br /> _Sanitary F'acilttles&�1?dumpster,kSlte Wor.k.Pennit,#or,sutitli,yi�Iglrts/Iarge;Prn),e,`ct�s;::.,.=y:=�;:` ;:,, ;��; , . �; . " ; .::*`,,� -
<br /> -- COP�1ME�tCiRL Attac�►{3)'�coinplete-sets�of'Bultding'Pian's plus a Ufe Safefy`Page;�1 j set of Energy Forms.R-O-W Permit for new canstru�#lon. �
<br /> Mfnimum ten(10)working deys after submittal date. Required onsite,CanstrucUon Plane,Stormwater Plans wi Silt Fence instailed,
<br /> Sanitary.FaciliUes&1 dumpster.Site Work Pem71t for all neinrpraiJects::All commerGal_ts�ulrements_must meat compUance r �
<br /> :S1GN�PERMIT Attadi{2)`sets of`Engineer,ec��Plan�z=��-�:�,u�. -_�:;�, .,_^� , -, _ .,
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<br /> � ""PROPERIY SURVEY requlred ior all„PIEW_�onstruc,Uon., ,_._. __.,. �• ; �
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<br /> I .�^I}}t8Ct10it8: , :-_��;�:,'�'�: � , -.,..,
<br /> ' �`Fill out applicatlan compl�tely.
<br /> Owner&Contractar sign 6ack of application,natarized �
<br /> If�avsr�500,�NoNce of;Commsnc�ment is rsqui�ed. {�tlG u�gr�cEes ove�57500}� --: ,< .
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<br /> '• Agent(fpr the cantrac�or)'o�Powe`r of AtWmey(fiur`fhe`owner)would tie'someune with notarized letter from owner authorizing same
<br /> 4VER-TFIE COU�i't��ixPEtttY11T1'IAtt3-.--,.;..{Fronfiaf-ApPticattomOn{y)_._._._. ' ` _ ^ ' -
<br /> Reroafs If shingles.µ.M"Seurers�.. Service Upgrades A/C Fences`(Plot/Survey/Foat�ge) . , J .t, i
<br /> ,...n:::<,3'sj.e ,
<br /> Drivawaya-Not aver Counter if on pablta roadways..needs 420V11"
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