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813-780-0020 City�of Zephyrhills Permit Application ; � , -��,� FeX-$�3aso-aa2�
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<br /> Date Recelved = Phar�e:Gant�ct�for�Permttt�n � ��'" �• �µ•���•� —�. :� -
<br /> Owner's Name Y � 1/� < �Z b(6 Owner Phane Number � � �
<br /> Owner's Addresa � � Owner Phone Number �.L'� �� ����
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<br /> Fee Slmple Tltleholder-Wama � � � Owner Phane Number � �
<br /> Fee Simpl�Titleholder Addrasa
<br /> dOB ADDRESS � V 3�1 Cd�.tw �„ �, ,� Ir� � LOT# �_�!�
<br /> SUBDIVfS10N ° P.ARCEL 1�# � �
<br /> • , _ : (OBTAINEDFROMPROPERTYTIUENOTICE)
<br /> WORK PROPOSED �NEW�CONS7'[t;• . ' ° ADDlAi:l' �'C„�" StGN .Q �C} DEMOI;ISH
<br /> .. � e.� INSTALL. 8.• : .REPAIR �- ,
<br /> PROPQ�E�?USE � SFR�_ � 'COMM ��=� �OTFtER'- � � , , .
<br />' TYPE OF CQNSTRUG'f10N [�J''� �'�BLOGK " [� 'FRAME �� ,STEEG �] �
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<br /> DESCRIPTiON OF WORK , '��� 'P�.. ��ti"�- � f " G p th-Vt,.-e c. . � C� .
<br /> BUICDIAtG:SEZE� �� , � &t�`FOCiTAGE�; • .,HEIGFiT±.��_---_��
<br /> QSUtl.Dif�tG ����. VALUATION"CY��TOTALCOi11S`i�`Rl1Ci'ION :F .' • _
<br /> QEl.ECTRICAI. $ RMP SERVICE Q �PROGRESS ENE�2GY [� W.R.E.G. '
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<br />' OPk.UMBING ,.� � ` _ (..� U�5�'y!c�
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<br /> �MECFIi4NIGAL $ VALUATION OF;MECHAPtiCAL INSTALLATiUN � �„fj ,�1�j��
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<br /> C]c�,s , Q RQOFlf�G _CJ SPECIA4TY, [,�] az���� � �
<br /> FIiVISHED FLOOR ELEVATIQNS r�� FI.00D ZONE AREA , ,QYES. NO
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<br /> SIGN/�TURE �"���. l� ��,j`� C, R OMRANY"_ �' Y/ N 'FEE CURRE� 7 N'.
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<br /> E�ECTFtICIAIft: ,_, � �}�:�� = �'CONlPANY . ''�
<br /> ' SIGNATURE �� �"^"����"V' � REGISTERED Y N �E cu►�ae�`-� 'r • G N' '
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<br /> Address � t , � license:#�.x f�i_.: t;f��� �-��r_�""' 1
<br /> PLUMBER�' � �GOMPA�+lY . . , •. ,. -
<br /> SIGNATURE'` �5 � ' � � _' _ � REGISTERED, Y./�N, ��ee Cu�tEn � `Y-/N �
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<br /> MEC!lRPIIGAi: , .+* , - � , " - ` GOMP�ANY _ _ „ :,�, rv
<br /> SIGNATURE> � " , � ` " �� - ' � REGIS7ERED�' Y../ N ' FeECURRE�:, Y./�N .
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<br /> $IGNATURE': �.r.,, . . • ... .. , . ,. . ..
<br /> ,COMP�AIY
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<br /> z,'� 4� ,'�=_)'�' ,�.w ':4` �"`t�REGIS7EREDk,• Y/ N;..: FEE CURRE� 1(/N.
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<br /> RESl�ENTlA�.,,�,.;:`;Ai#acti�"{?)aPfof:Pfa'tis;::{2�}sets<of�Bu11if1ngtPlan§;{1j setafi�En`ergy��ortns;RR=O=W�Peimit for nsw canstruc:#lan. -
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<br /> -:.-;;,�,�.��Minimum�,tep�(�10)r�working�days�aiter;sutimltfal'dafe:�:Required onslte;;Consti�ctlon�Plans;`Stortnwate�Plans=w/Si(t Fence instatled, �
<br /> - ` � Sanitary FacjllUes&Ylhdumpster,,Site Woric�Permit;�dr su6divislonsnarge.proJects;,t;,�;a:;;•: '. . :�,.=., ``' s� � ` " �: :�°„ -
<br /> CO1VlMERCiA� Attach(3)`cbrsiplete sets`af�8ultiling Ftaiis pius a Ufe Safefy�Page;{1}set of Energy Fotms.R-O-W Permtt#or new constructton.
<br /> Minlmum ten(10)working days'afker submittal date. Required oaslte,Constructlan Plans,Stornavsrater Plans w/Silt Fenu�installed, -
<br /> Sanitary Facillties&1 dumpster.Site Work Pertnit for all newtprrijacfs..AJI commerclal�[.etlulr.aments.must meet campliance '
<br /> ::S1GN PEi3MIT Attacti'�2)"s'ets a`f'Engi�eeied;,Plans:, ,_,�-3u>= ,.;�e r :.. . - � �
<br /> � N4MpROPERTY SURVEY reguire�d,for aU�N�W construcUbn.., _ �•� - � � ' _ .
<br /> -�Y�EHYNO�I�: .wt".s :,L�<d. .. . . _ . ..
<br /> � Fill out applicatlon completely. '
<br /> �i Owner&Ca�tractor stgn bacic of appl[catton.notar(zed �
<br /> � If OYBT�'�"JOO,a Natice of Cammencem�nt is tv�quired. {A/C apgrade�aver�7500j ., . . ,
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<br /> Agent(for the cantraotor)'cr`Power`of Attomey`(fiir the oviiner)�woul'd be'someone with notarized letter from owner autho�izing same I
<br /> DitER THE Ct�UN'FER:PERMI'1`'17AlG._...,__,�.{�rontaf-Appticatton�Onty)_. ._._.' � �• � i
<br /> Reroofs If shingles Sewers Servlce Upgrades A/C _ Fences(PIoUSurvey/Foatage) _,
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<br /> Drivswaya-f�tflt over Caunter if on public roadways..6eed"s ROW
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