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<br /> ;s��-�saooao City of Zephyrhills Permit Application Fax-813-780-4021
<br /> BuElding Departrnent .
<br /> Received �
<br /> 1� ' ^ Phone�Castifact�far Permiitf(n '
<br /> �wner`s Name � • Gt e � � �1� �`,(.� 4wner Phane Number �' `7 �""' ,�,
<br /> Ownar's Address �f l...U� 4/ Owner Phane Number �� ��
<br /> Fee Slmple TItleFiolder Name �� ��-� ' Owner Phone Numbe� � �
<br /> Fee Slmple Tltleholder Address
<br /> JOB ADDRESS i sl_(l � LOT# ��
<br /> SUBDIWSIQN c)!�U�� C�t�S � PARCEI.ID# - ,
<br /> - . (OBTAINED F.RdM.PROPERTYTAX NQTICE)
<br /> WORK PROPt}SED. NEW CONSTR ADD/ALT � S1GN' 'Q [� DEMQLISH
<br /> e. INSTALL 8 .REPAIR
<br /> PROPOSED.USE , Q SFR Q COMM � OTNEF2
<br /> TYPE OF CdNSTRUCTION Q` �•BLOCK " Q FRAME [� STEEC 'Q
<br /> s ��/} -
<br /> DESCRIPTION OF WORK•' /Z e Gvt. (�Q,� '�j C'x(Jt�/`
<br /> BUILDING SIZE � T�'$Q'FOd7AGE�� > ;HEI,f3HT���„ �
<br /> �������`�'' • ��. VALUATION�OF`TOTAL CfONSTRUCTION '
<br /> �.�J
<br /> QE�ECTRICAi. �� AMP$ERt/ICE, Q PROGRESS Eh1ERGY [� W.R.E.C. „
<br /> �Pl.UMBlNC� ,� _. ��(/- �.
<br /> QMEGHANICAL $ VALpATtON OF,MECHAtVICA�INSTA�1.,4i'IOtV
<br /> ��..��'.
<br /> QGAS Q E200FING Q SPECIAI.TY [� OTtiER
<br /> FINI$HED FLOOR ELEVATIONS r�� F1.00D ZONE AREA �]YE3 1 NO
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<br /> BUIGpER COMPANY� � � '
<br /> SIGNATURE REC�ISTERED Y/ N ��E CUR�n ` Y/N' .
<br /> Addre�a � Lir,ense#'� � �
<br /> EIEGTRlCIAi+l: ,.;, , - ;'COMPANY ' -
<br /> SIGNATURE � REC,ISTERED Y/ N FEE CURREK°� ` ��-Y/N
<br /> Address ' , . „ - License;#.� - ��
<br /> PLUMBER'_ , COMP,At�IY � , CJi{/�tl f�^t� �t.{.,J� .
<br /> SIGNATURE=' � � � r � , ,REGISTE�RED , Y./s.N: ., .;FEECURRE� '" Y>/N.c,
<br /> A�daress �7i�.. 17a�GL '_ �-�� i+S �`"� License.,# . � "�';r�..26��:� �.
<br /> MECMR[iiiCAl: ' "' . . . . CC?MPANY , • ,
<br /> SIGNATURE ' � • - ' ' ' `
<br /> REGISTEEtED Y_/ 1V + FEE CURRE�. Y/�N , ,
<br /> Addrsas: ,` . ... .. .:.. .. .. . . � , - ' ` Licsnse#��� . , � .
<br /> OTHER ?� . . ,.., . , .._ . � t=COMPANY' � , _ .
<br /> SIGNATURE- , •. ":� ' • �" • •' " ' ° ' � ~�REGISTEREp' ' Y/ N:-... ` '=FEE CURRE� YY N
<br /> Address . ,�,,_ . . - - , �Cicerise# � � .� .`
<br /> RESlDENi1A1:�`; A�kaeti`(2}vplot;Plan's;>(2}sets:'of{Biillil3ng�Plans;{1.}:et o�:Eiiergyr;€oims;�}3A�W'Reririlt fnr new construction, _ � ` - ' '
<br /> � - �.� Mlnimum:,tem(1.0);worktng`days�after;submittaldake:<;R:equlred�onsite;'Canstnicdan:Plans;Stormwa'terPlans:w%Silf'Fence.inst�lled, � _
<br /> � '�_�Sanitary Eacillties;s��3du�i�ter.;sic@,wo�:Permit tor sutidivislons!large;Rrojects;=�=_�.�c.. �, --� , �,,?,'.:.:�-_ ," _ - . °
<br /> `-COMMERClAt. Attech.{3}•coinplete sets`6f Buililtiig`Plaits ptus a tlfe Safiety`}'age;('1}.§et of°Energy Fcrms.R O-Y+1 Permit far new.construoHon.r�� `.
<br /> � Minimum ten(10)working days afker submittal dake. Requlred onsite,Construotion Plans,Stormwater Plans w/Silt Fence installed,
<br /> Sanlfary.Facilitles•8�:4 dumpster.Stte Work Permk for ail new proJects:.All commerciai requfremen�mustmeet compitanca%" �� • -
<br /> SIGN PERMI'i' A#tai�{2)sefs 6f'Engtneer.ed%Plans:, . .. � .' :� ,., - - . - " °' �=` , ,�:',, .,,,,', .
<br /> ,.:,. .. s
<br /> ""•PROPERTY BURVEY required for aII.NEW_constructian. . , _ .. - - - ' - --
<br /> Direcflons: ..:_.°;- , . _ . , . . :, _. . .._ . �..
<br /> Ftll out appllcadon completely.
<br /> 6?wner&C;onUactoc slgn back of.apgifcatton,no�rized
<br /> if over�2500,a Notice of Commencement is required. (A/C upgrades over ST50d) , '
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<br /> .,. :.�,....,.�:��.:� _ ... ,. .. .,,,..
<br /> '• Agenh(for the contractar)or"P"o'we�of Attomey(tu�tfie�ownerj iwould be someone with notarizad letter from owner autho�izing same ,
<br /> : ....x.i _ :f�.,_._>;,..:. .�
<br /> DVER TIiE CCiUNTER P-ERMi1'T'iNt3-• --- •(Front of�Applica#ion On{y}�-��--•
<br /> ;. ,. _. . .. -
<br /> Reroafs if s6ingles Sewers Service Upgrades A/G Fences(Piot/Survey/Footage)
<br /> _.__.., ,......__. _,___ .. ._. .. . � , -• - � . � .N; _ -
<br /> Drivewaya-Not aver Counter if on pubiic roadways:.needs ROW .
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