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813-780-0020 City of Zephyrhills Permit Applic�tion Fax-813-78Q-0021
<br /> BuAding Qepattment _
<br /> Date Receiv�d '—� — �� ._ _��;�Phane�Contact��for�Rermittle ; � �� ,� °��Z�v - ��
<br /> /�j� � ,. _ , . ,, ,
<br /> Owner's Naroe , 2�" �/// l `'�' � Own�r Phane A{amber �
<br /> owner'�Address y.� /�L/yl'l� � ��d�i, ° ' Owrner Phone Numbsr �— � �
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<br /> Fee 81mp1�Tltleholder.Name � � • � � Owner Phane Nuronber ''�— �
<br />' Fee 9tmple Titl�holde�r Address �
<br /> �os ano�Ess �� ��Z�'� S'1 '� ti.` f S 1�L ��✓��� LOT�F ��,�
<br /> I'i StIBDlVISIOFt � - � P.ARCEL,.ID# '��z�G 1 d�I� .. �,j PO ��% �
<br /> - ; - � i , .,, IOQ,TAINED:F.R�M PROPERTYTIIX NOTICE) �
<br />� WORK PROPOSED �..�..NEt�t.CONSTR" ADDIAI:T C�� SIGN .Q �Q DEMOCfSH
<br /> . ,.';�, ,;IPISTALL. 8 -,"REPAIR .. �
<br />� PROPQSED?US� � . , ` �-0 SFR, [� ' CC?MM ,- `��[� �QTIiER , . , -
<br /> TYPE OF CON3TRUGTfON �_,_�`'� ' BLOCK ' � 'RRAME , .. „
<br /> :� ;'STEEL' [� _ '
<br /> DE�CRIPTiON OF WORK i� „�� � �'� ,_` -
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<br /> �tl1LplAtG`SIZE�`" _ : � . :
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<br /> �� �"SQ'FOQTAfE v" . ..HEIGMT�~
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<br /> QSUII.RtNG $ vALUATlO{11it}��TGOTAL�CONS'1'F2tJC'610Iti1 ° � , .
<br /> . 2 Z ,� , .,
<br /> Q��LEGTRIGAL $ AMP SERVIGE - � �PRt?GRESS ENERGY �� UV:R.E.C.
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<br /> OF?kUfVlBlIUG . $ '
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<br /> � QMECHANlGAL $ . VALfJt�TION OF;M�CHANtCAG IIVSTALLATlON_ fl f�
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<br /> QGAS ROOFIt�G [� SPECIAL7Y C� OTHER�. � •
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<br /> �, FINISHED FLOOR ELEVATIONS I�. _� FLOOD ZONE AREA QYES. NO '
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<br /> BU11.f}ER . COII�P'i4Nlf" , , �
<br /> SiGNNTUR� REGISTERED Y/ N 'FEE CURRE� ` Y/'N" '� ` :
<br /> Addrass ' - Ltcense# � = ` �
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<br /> ECEGTttIC1ANr, __-,, . . . �• r.�COMPANY ' ° - � ' � •
<br /> SIGNATURE � REGISTERED Y/ N FEE�CUF�REKt' �"' �'�Y/N` � �
<br /> AtldP6�s` ' � , . ._ . L�G9nSe�#�:)i � �.�_ y �
<br /> PLUMS�R"�` � . GQMPAI�lY ...., - .
<br /> SIGNATd1RE'�� .`�`; s- _' ' r� REGISTEREQ, Y/s.N�^ rFEE;CU,RREP � . ��YIN'. '
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<br /> Adc�ress . � ` x� � , �,=Licerisew# �.--_, , , ---;-,
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<br /> MECHANIC�d:'; '+,' . - � ... .. � GOMAANY . , �_-�, A �•- ". -
<br /> SIGNATURE� • " " ' � '� " ' ' ' " '{` { REGISTERED,f Y./ N FEECURRE�:. - Y,�:N ,
<br /> • ip�: �" _ i _��:rv';_ �• .�, `{ �O:l" : _ ; ' .. .. ''�.^;„^. .;� � .
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<br /> Addrass� . . - ,.. , _ � .. , - � . , ,4e..,&.
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<br /> Q?HER .. �,Y �, "��C..,� - ;,�-�--.-=-' , , .` � .�CON! �►NY ou'�'�i1'.�:. �� n. -
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<br /> SIGNATURE' �, :qy .. ',e';. ''�'REGIStEREO� ' y 'Y/ N..p FEE CIJRRE� Y/(V.
<br /> �aa���. ���,3g�,�'�!d',:._/�aU.":�,. ...c�';t:.Z ��+:.y��3.5"'- r: � ,,, � .:��cei�s�#�����G"f.��'/�� ' 1 `
<br /> . , ,t Y r - c [.�,,. . '. y:..r+ '' �,:.w... -' ' -' _ rY'. ' `
<br /> � 2 �,,� '_ "�3`3^i'�'"' .I�i.kG p .ny,. '�A�.... r� _,
<br /> 1tE310E�9, � `�_• „':Attacti�(?),Pto�.P,.,la`ns;,,(2)seistofa8ulldMgfF"lan`s;`(1}setot'���nergytFo`r�ns;�12=Q=1'tV'Permitfb�new°i�onstrucUon,�
<br /> ���� ,< ,. f.,-�..., �:-„ �„ . ._. . ,,.�.. . ._ ."• -
<br /> ==y;`µ��4��=Minlmum�teny(�1,0);,viror�tng;'�.days�aiter�subi�iilftalyd`at'e.�Ftequlred anslte;;Constru��oi►:Ptans;`Stonnwatea`Plans•w/SIIt Fence�iristatled, -
<br /> Sanitary Fac�llties&R1�dumpsterySlte Work�Permit�.t6rksulidivisiqns/large;�ro)ects,_:;_�;;,��;",r . ��=M,•;.�. •3'� ' � }�. . , .
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<br /> COMMERCIAt. Attadt{3)�coinrplete'ssts'�of SultiSing Plans pius a.�ifee"Safety Page;{'1)set af Eitergy Forms.R-La-W Fermit for neuv constructton.
<br /> Minlmum ten(10)wrorking deys after submittal date. Requtred onsite,Ganstruc#ian Pians,Stormwater Plans w/Slit Fence instailed,
<br /> Sanitary FacillUes 81 dumpster.Slta Work Pertnit for all new<proJects:.AU commercial�Cequirements_must meet compllence �
<br /> ,:x;Si�N'PERMIT Attar.tii"(2):se#scf"Eng�`r�eeTed;;l?i'_ans:�,�-;��w:::; ,t.,���:��-�7ri- r ' . � .
<br /> � •"""PROPERTY SURVEY regulred for all„NEW.aonstrucd`on.._... _ _... _ - � _
<br /> � ..✓5J _
<br /> F �Y��9Y���leY� .;t�i..l_...-r�r_. r..e� .� _" ' ."' s. ' '
<br /> FIII°out applica8an completeiy.
<br /> .Ownar&Conhactor sign back of appltcaUon,natactzed �
<br /> If ovar�SOO.s Natice.of:Comrnencement Is r�qulrad. {AtC upgrades over 57500} - .
<br /> ai 4s,�,",.��yi;''.'..'']t,�',o �' - _
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<br /> Agent'(far.the�oontracto�)'or Powe��of AtCamey�(fo�the ovuner)'would be'someone with notarized letter from owner authodzing same
<br /> ,DVER�'t'ME COUN'iER;:PERMIT11t�lGw.-�.;�.(FrontofAppltc;ation-Oniy}�-- ._ ._ ' - .. , .
<br /> Reroofs(f shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Foatage)
<br /> �<;�;,�:;5.:- '. .`r. ` .= ".. , _ . . � , _ �..
<br /> Oriveways-Not aver Counter[f on publEc roads+vays:.need"s Rt}W
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