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813-780-0020 City of Zephyrhills Permit Application Fax 813-780-0021
<br /> Building Departrnent _
<br /> Date Re�elyed � y ' ; �,Phone.Contact:fae:Permiltln � - '
<br /> Owner'a Name ' � • �IM Owner Phone Numbee O I lQ,
<br /> Owner's Address � � � ' Owoer Phone.Number• '
<br /> Fee Slmple.TltleNolderName � � Owner Phone Number ��
<br /> . ^.,.-s. � _
<br /> Fee Simple Titleholder Address - �
<br /> JOB ADDi2ESS J — {�t �V �j , LOT# �
<br /> SUBDIVISIOFI PI�CEL�ID# .� • �
<br /> - , , (OBYAINED F.ROM.PROPERT1f,TAX NOTICE)
<br /> WIORK PROPOSED =�NEW CONSTR . ADD/ALT �]� SIGN' "Q Q DEMOLISH
<br /> , . 8; INSTALL� � ..-REPAIR
<br /> PROPOSED�.U$� � , Q - SFR. [� COMM . Q �OTHER ' �
<br /> TYPE OF CONSTRUCTION^�� �O` �a•'BLOCK r Q� FRAME ' '� 'STEEL' '� � � ,
<br /> DESCRIPTION OF WORK' '+. � S�'��D I ZF Z��T-
<br /> BUILDING�SIZE�` � � �"SQ'FOOTAGE�, ,H,EI.GIiT� .�
<br /> .,� = -
<br /> QBUILDING $ 2 � � VALUATION�:bF`TOTAL-CONSTRUCTION^` - � I
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<br /> Q ELECTRICAL $ - AMP SERVICE. � ' Q' "PROGRESS ENERGY Q W:R.E.C.
<br /> QPLUMBING • $ - ��� �O���
<br /> QMECHANIGAL' . $ � ' � 'VALUATION'O�MECHANI.C/�GINSTALLATION:
<br /> ��S [� ROOFING ;Q; � SFECIAL'iY;;O,_ ,:OTIiER�, r
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QY�S. ,NO
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<br /> BUILDER COMPANY�` � ` -"- �'
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<br /> 31GNATURE REGISTERED Y/ N . �`:�FEE CURitE�' ° Y/�N' � �
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<br /> Address ;_ , . • : �:� -. ;Ltcensei#' ' •
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<br /> ELECTRICIA1d_ - . . • • S'•COMPANY ":- ;r, ;_� ' - .
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<br /> SIGNATURE � ,�GISTERe� Y/ N �E:Gu�Kr:{ 'f' _�'Y/'N' - '� . ` � -
<br /> Address` .., . ... , , . .. , _ - . :. ..- ., _ , �a,. ., License,#�•; . , �, . �. ,
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<br /> PLUMBER�' � ,: , • , ,C.OMPANY � ;': :�,:. ' ' ;"_ ,- ,� ° ' ,
<br /> SIGPIATURE'' �'=` . ' . . _ .. ` `REGIS.T.ERED ' ,X./,.N:•: �,,,,Y;FEECURRE�,,` - �.Y:-/,N. �
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<br /> Address , � .. � . ,,. , ..r . ., �Llceiise�#� _ ,. : �. � � I�
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<br /> MECHANICAI:` :. ... • , � _ , : ' COMPANY � -. -.i . , � ,..:.. ,-�; -�, ;�� , .
<br /> SIGNATUREL . '-�-? " ;`,�. " . , , , - - " . � REGI$TERED , Y,/,N ,'.s�FEE'CURRE�.;., °Y./N..,: ,.
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<br /> Addresa:'�..- � • , '-`: , .z:. .. _ , . , , , � .oy, } • _.. , , �. , , ,
<br /> Ltcense#'
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<br /> OTHER ,.r,... ' , .. _, .� _ ',COM,PANY,.- , , .. . - �:.:_ -` .. .
<br /> SIGNATURE•. u ';;- �-�� ::_�•, -�. . , - -_ :r':. , - ,.:i - .. •t� - �3 .. . , .. . _
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<br /> �RESIDENTIAL' -Attach*2 PCot�Plan , •, . . �.v" . ,.�,.`:�. .� „��.,.��.:�, .�._,.. :•_�-w :::.�._.,: ,,,F,,.� _:. :,... .
<br /> _ .__ .(_)d 's;�(2)set's=of.:Buildirigi:Plan"s;`(.1)'s`et'of.Energy=Forms;R=O=W�Permitfo�new•con`struodon,
<br /> �.,�r. ,a.;.�.�.. �,.. ,=r.a�.,. -;.. ,..,, . .
<br /> ;-y�_y�;�Mflnimum��ten..(�1,0)�wo�tng;da�ys�after;sgbmitfal:d"ete.':..R'equired onsite;;GonstnicdonrPlans',Stonnwater=Plans w%Silt Fence installeii,
<br /> Sanitary Facilides�&t1}�dur,r�pster.,Site�.,W,orkEPermit;for•subtliyislons/lerge:projects'w;�=b�,ir�}, �":.:-;n;'_. ,� • `� '�ia •
<br /> COiHFJIERCl/!L Attach 3''com`IeCe'�sets'of`Bulldtn'"Plans``lus a`�Life Safe����Pa e;"1 sef of Ene Forms.R-O-W Permit for new�consUuction.•' .
<br /> . � ) P 9 P tY 9 � ) � � �'9Y
<br /> Minimum ten(10)working days after submittal date. Required onsite,ConsUucUon Plans,Stortnwater Plans w/Silt Fence Instalted,
<br /> Sanitary Facilttles 8 1 durropster.Stte Work Permlt for all newiproJ�Cts::.All commerclal requlrements_must meet campllence��"� '
<br /> SIGNPERMI7 Attach'(2)sefsofEngCne@[edrPlaps:�,::��,�xf,'>a�:-:;:_ ,s�;;.r .. _ :.� �- ' � � - �
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<br /> "'•PROPERTY SURVEY�eyulred for all.NEW construcUon.. _.. . ._. . •- -
<br /> - - `�-
<br /> jDlfectiOnB: _.,.:���;+....,��. ._ .. . • -
<br /> Flil out applicaUon completely.
<br /> Owner 8 Contractor sign back of applfcaUon,notaAzed
<br /> If over$2500,a,Notice of Commencement Ia required. (A!C up�rade�over�T500)
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<br /> Agent(for the contractor)or PoweP of Attoiiiey(for the owner)�would be someone with notarized letter from owner authoriaing same :
<br /> OVER�THE COUN.T.ER:P.:ERMITTING�•�-•�-;-(Front�of•Applicatlon-0nly)--�- ' � - ` � ,
<br /> Reroofs If shingles Sewrers Service Upgrades A/C Fences(PIot/Survey/Footage)
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<br /> Drivewaya-Not over Counter if on public roadvrays.:rieeds�ROW �� � ,r _.-<- .-
<br /> .ra:..t.suseers.c.ad.-.r.:�_.:..s.;.w. . ....:. ... .� •, ,.Zb�•o~n..n:s:.-xW..,s..r•:krma::.J,e.....,;.
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