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<br /> �„-'�0-�°l� City of Zephyrhills Permit Appiication Fax-813-780-0021 �
<br /> � = - . Building Department ,
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<br /> Date Recelved ("'�J, � �t.�� ' Sa 1
<br /> •. Phonu•ContactforPermtttin c� �'� �
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<br /> Owner's Name d� ��r'�. �G-/'�'�/� Owner Phone Number G�����Q � �T�� {' I
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<br /> Owners Address E Qwnar Phone Number' ,,
<br /> Fee Simple Titiehotder Name Owner.Phone Number � � �
<br /> Fee Simple Tittehoider Address
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<br /> ,ros����ss 5 le �ca �� , �o�r# '
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<br /> su�o�v�s�o� � 1 �R-�1�t�„ er pa�tc��.�� 5' �" �1 �f.�5'� DdDDD /!}`�c� '`
<br /> _ (OBTAINED FROM PROPERTY,TAX N0710E) '
<br /> WORK PRiDPOSER _NEW CON5TR- ADDtALT Q SIGN Q ` C} DEMQLtSH
<br /> >e. INSTALt ,-REPAiR �- . �
<br /> PROPOSED�USE Q SFR, C] �GOMM- Q OTHER � ;
<br />' 'IYPE OF CONSTRUCTit'�N Q� BtOCK " � FRAME �� STEEI' �Q '
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<br /> DESCRIP'CION UF WORK ,. �, �G � �ttl� =rs u � '� �rr�� vs�f���� �. �'�� �
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<br /> BUILDlMG SlZE SQ FOOTAGE " HElGtiT .
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<br /> QBUILDMG �� yAlUAT10N QF'i'tOTAL CONSTi2liCT10N - ' .
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<br /> QELECTRICAL �-T-�==� ANIP SERVICE [� PROGR,ESS ENERGY [� W.R.E,C. �
<br />� QPL:UMBING � � i
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<br /> QMECHANICAL $ � VALUATION OF MECHANICAL INSTALLATION +
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<br /> ��As [� ROOFING [� SPECIAL7Y Q OTHER ;
<br /> FtNISHED F�OOR EIEVATtONS � � FLOOD zONE AREA QYES. ,NO �
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<br /> 9UILDER COMPANY'• � �
<br /> StGNATtlRE REGISTERED Y I N 'FE6 GURREP Y/N �
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<br /> Address ' tJcense#'1" �
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<br /> El.ECTRICIAN: '�OMPANY -' i
<br /> $IGNATIIRE � REGlSTERED Y J N FEE GClt2REI�`' ~~Y 1 N - �
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<br /> Atldre8s - t.IC8ttS8-# � �
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<br /> PLUMBER ` COMPANY , -
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<br /> StGNATUR6 ' ° R���s.rEitEa.. � Y.l,N., :�cu� ° Y-J N �
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<br /> Address I.fcense# �� �
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<br /> MECHANICAL' ` � , ` ' ' _ COMPANY �/'�j�IQS .+� !A/1I�G�� . G�' �
<br /> SIGNATURE ' �� z R��1sT�a�o. Y.1 N . � �E cu�� . - Y 1-N
<br /> Add�ess•. `f��t �lfU'/� l`C.t��r G�1"`�f ��3T� ucense#�ti�f�;(=o Y`'3�'�'� �
<br /> , or�eR � -:coMPArnr. . - � -
<br /> 'i Stt3NATtlRE -'�' ' � " REG1s7ERED'' `T 1'Iy._ FEE Ctlt2ltEt� Y 1 N.
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<br /> Address �,�5�,� � - : �;- . . " License#`� �
<br /> RESIDENTIAL�: ;AttacFi"(2)„Plot;P,lan`s;::(2)sets.:af<Bull�ding�Plans;'(i)set of'Eneigy�Fonns;'R�"-C1�VU+Perir,if fb.r new construction,, "
<br /> �Mlnimum�ten°{l4j;worlting�d'a}±sjafter:;sutiinl#tal'date;K:Requiiiaii onsite;.Coastivcttori3Plans;$#ormwater-`Pia»s�wJ S�it Fence tnstalted,
<br /> «• ._3�Z«t—-"er.� . .. .�f}- . —
<br /> SaniteryFacllitiesr&�1„dumpste_r,-�Sita°4VorksP�rmit�finr,sutidivisionsAaige:P�J!���;:;..:'i� :` • „ ' , .
<br /> COMMERCIAL Attach(3)`c`so'myplete sets'of'Buildfng'Plans'plus a Life S'afety Page;�(1)set of Energy Forms.R-O-W Permit for neW constructlon.
<br /> _ . Minimum ten.(10)working days after submlttai date. Etequlred anslte,ConsUuction Ptans,S#crmwater Ptans wl Silt Fence tnstatiled, --
<br /> Sanitary FaGlides&1 dumpster.Site Work Permit far all new��proJects..All commetcial requirQments�must meet campllance -
<br /> 31GN PERMIT AttacYi'(2)sets ofEnglnee[ednPlans:i;�.•,-�_,, �.;�•:� ,-. .�
<br /> •"'PROPER7Y SURttEY requlred fat ait.h1EVlt ccnstruc�on.. .. �
<br /> DlrecNons: r ,. - - .
<br /> Fil1 out applicatlon completely.
<br /> Owner 8 Conlrector sign back of appllcadon,notarized �
<br /> li over 52500�a Notice.of Commencemeet Is required. (AlC upgrades over�7500�
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<br /> '" P�qent(for ttte cantractar}ot'Powe"r'csf Attorriey(for ttie awner}�wouti!be aomeone with notarized te#ker from owner authorizing same
<br /> CiYER THE COUNTER;pERMITf1NG �•-,•�{Front of•Appticatlon Only)•� • , _ . _
<br /> Reroofs tf shingles Sewers Servke Upgrades A/C _Fences{RlotlSurveylFaotage} : : , � °- - _
<br /> Drivewaya-Not over Counter if on publfc roadways..needs.ROW ' �' ' I . , , j :' �—
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