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�"''��Q2° City of Z�phyrhiils Permit App(ication Fax 813aao-oo2�
<br /> �" Bullding bepartment .
<br /> � �
<br /> Date Recelved �- �� , Phone�Contaat forPermittln S�. � �''���/� '
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<br /> Owner'a Name 9� Owner Phone Number �/ / �� • �
<br /> Qwner's Address Owner Phone Number � � �
<br /> Fse Slmple Titleholder Name �— � Owrier Phone Number � � ��
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<br /> Fee Slmpte Tittaholder_Addres� fi
<br /> JOS ADDRESS I I �.OT# �_____� ,
<br /> sueQ�vtstaH �� �tx ; _ ��cE�.�� " ` �S� I�l� ��� � t<YC�C? !
<br /> (OB7AINED EROM PROPERTYTAX NdTICE) i:
<br /> WORK PROPOSEQ �NEW GONSfR� ADE?/ALT �' S{CiN' 'Q Q DEMOLISH :
<br /> INSTALL 8 , REPAIR - ,� �' i
<br /> pROPO5ED,U5E [� SFR� [] COMM• � OTHER �FQr�?�[� �„', �.,.,�,p�y,�.� J r���' !'
<br /> TYPE OF CONSTRUCTION Q� , BLOCK " Q PRAME � �� STEEL [� - ��_� � i
<br /> DE8CRIPTtON OF WORK .,.- �,�771Q-r",7 j� `
<br /> 6
<br /> auic.o�r��s�z� sa�oora����: - ,x���H�r����.� .
<br /> QBUILDING �� VALUATION OF`'1'tOTAL CONS'F'RllCTION '
<br /> �
<br /> QELECTRICAL �� AMP SERYICE Q PROGRESS ENERGY Q W.R.E.C.
<br /> QPLUMBING �s=� - �
<br /> �MECFiAPIICAL $� S,j VALUATION OF.MECHANICAL INSTAI,IATION �
<br /> �_S1_�L..._.�.J�. - 4
<br /> C]c�►s Q ROQFING �] SPECIAL'iY �� OTHER !
<br /> FIt+i1SNED F�00R ELEVATtflNS �..�� FLOOD zONE AREA QYES. NO ;
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<br /> 9UILDER � COMPAMY , �
<br /> - �i��'�l2F - - - - - - R��tSt��a - ——Y! td-�- -���CURa�n __ Y 1� _ - - -
<br /> Addre�s � - _ �
<br /> k:icenss#'� �
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<br /> B4ECTRICIAN � COMPANY ' �
<br /> SIGNATURE � REGlSTERED Y 1 N FEE CUitRERv' • h'°Y/N �
<br /> Addr+�ss . , �.Ecense# �^ � � ;
<br /> PIUMBER ` � COMP.,ANIf �
<br /> SiGNATURE' - - r .tt��ta�a, - Y.t:N., :,, ,.,FEE�cu�t� Y i N�. � ,
<br /> Addreas Ucense,# �� �
<br /> MECHANICAI:' COMPANY, � � 1..-- .
<br /> SIt3NATUttE. � - ' R�cist�R� ,� N . �cuR�. :N
<br /> Addre�s' l � ,Lfcens.e# ��-j��c�t:l.-� T�� -
<br /> pTHER . � � �,COIRAPANY � �, •
<br /> BtGNAtURE' �: : . , •" . . ` ` R���siE�o �- Y i'N :, '" �f��Cti�RE�: Y 1 N.
<br /> Address/ ,.t~ � , . � � '� � liceiise#'�� � �
<br /> M. M., h....,. , ti�y,�< s: ��,,��,,:.:, , ,_.
<br /> RESIDENTIAL;s ,:Attacfi"(2),;Pl'o't'.Plans;:(2)sefs;of:Building'iFl��s;'(1)'set of�Energy�Farms;R=Q=W'Per'mif fc.r new construcdon,
<br /> �..:,t:,.�lVttnimumGten;(:�,4)�warking;days�atker"'sutiinitt�il date.r;Requiied ansite,;-Gon§tnictton�Plans;Stormuv�ifet Ptans�w!SIIt�Fence installed,
<br /> r Sanitery Facl�iyes.&s�1;,dumpstery;8ite`�M1►orlc;Permit;#or.:suticltyisionsAaige�pmjects�;.,,�;':..�•-
<br /> COMMEEtCld4l. Atmch(3)•cai'reiplete sets{`of'Bulldfng'Plans'plus a Cife`S'afety Page;�(1a set af Energy Forms.R-O-W Permit for new construction.
<br /> tut(ntmum tett(10)worfcing days after submlttat date. Requlred onslte,ConsttucNan Plans,Stormwater P1ans wl Silt Fence lnsffitled,
<br /> Sanitery FaGlt�es&1 dumpster.31te Work Permit for all new.projects.All commerclal requi[emenks.must meet compllance -
<br /> 51GN PERMIT Attaciti'(2)sets of Eilglneer.e.d�Plans; _ - `��-� . � `
<br /> ""PROPER'fY SURVEY regulrad for all ME1N construc�on.,
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<br /> Dlrectlons: .., - � . '
<br /> Ffll out apptica�or�comptetety.
<br /> Owner 8 Cantrector slgn baak of appllcatlon,notarized �
<br /> If over�2500R a Nctice of Commencament la requlred. (A!C upgradss cver ST500)
<br /> ,.'.'4:r'�`-fu:;,t-y�`
<br /> '* Agent(for tiie contraotot}'or Pawer of Attoriiey(for ttie owner)woutd be someone wtth natarized letter finm awner authorizing same
<br /> OVER THE COUNTER}PERM17T1NG --- •(Front of•Appllca8an-Only)•- - •
<br /> i2eroafs If shingles Sewers Service Upgrades AlC FenCes{Piof/SurveylFootage)
<br /> Drlveways-Not over Counter If on pubtic roadways..�eeds ROW s•.� - - - -- -��,:__ _ : _, ., _ .-
<br /> . _-_.. ...r,ry. ,.. ...i,.a.t s,.. .._.,.n...... .. _...�.. _ , .:ra,�,`1�_, ,
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<br /> �'� _y. " �. , .. � .,. �..'� �. ' �:y...�t...... a, i K-_. < .„a..s...�. ,' ` ., i����
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