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<br /> 813-780-0020 Gity of ZephyrhiAs Permit Application Fax 813-7aaoa2�
<br /> Building Department -
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<br /> Date Recelved � P.hone=Gontact'for Permittin
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<br /> Owner'�Name � -c' /'�d��( Owner Phone Flumber ,_
<br /> Owne�'s Address � � t � Owner Phbne Number. � �-
<br /> Fee Simple Tltleholder.Name � � �Owner Phone Number � �
<br /> Fee Slm�le Tltlehalder Addre�s
<br /> JOB ACIDRES$ �-5 V " '� (L� � � LO7# ���
<br /> SUBDIViS10N �� � PARCEL tD# � �j `� � �'�����l�~�7���—�� ,
<br /> _ (dBTAtNEDFROM,PRQPERTY,TAXNOTtCEy
<br /> WORK PROP03ED NEW�CONSTR ADDlA�T [� SIGN' '[�� �Q� � DEMOLlSH
<br /> � ' e� INSTALL 8 REPAlR � '
<br /> PROPOSEQ,USE [�] SFR � COMM L� QTHER '"" � '
<br /> TYPE OF CONSTRUCI`ION � BLOGK, " `Q FRPiME � `STEE� Q
<br /> DESCRtPTION OF WORK• --x � � �� �C�I G � '
<br /> SUILDING SlZE � �"SQ.FOOTAGE =2'^�� ; HEIGHT���,��
<br /> QBUlLQlNG , $���—� � VA�UATiOIV,OF�'t'tJTAI:CANSTRi1CTION -! � ' ,
<br /> QELEGTRIGAL , ($ �� AMP SERVICE Q PROGRESS ENERGY [� W:R.E:C. ,�
<br /> (�
<br /> QPLUMBING� $ ` `
<br /> _� ��-.-� ���,�-
<br /> QMECHANIGAL $ VACUATION OF:MECMANICAL INSTALLATION .����,,�i^' � ,
<br /> QGAS Q ROOFING _Q SPECIALTY.0 OTHER - '
<br /> FIIVISHED FLOOR ELEVATIONS ��� FLOOD ZONE AREA QYES :NO
<br /> BUkLDER J��� _.._...�. COMPANY� ��p�Yt � —�(�<,'� '.
<br /> SIGNATURE REGISTEREQ Y/ N � FEE GURREt� ' Y/N�
<br /> Address Sf,�� �t ,� �� '�-2 License#'� �
<br /> ELEC71tIClAN. ., COMPA�VY� � , '
<br /> 51GNATURE � REGISTERED Y/ N PEE CURREK��' '' �-Y/N
<br /> Addre�s �� � � � � , , , License#•i` . � I
<br /> f�LUNlSER ' . � CtaMP.l�if+lY .�
<br /> SIGNATURE ' , .REGISTERED Y.I..N:� --;FEE CURREP Y�/N. , '
<br /> ,.. . ' �
<br /> Address � ,.License„# � „ ----�.
<br /> MEGHANICAL: � � GQMPAMlf '
<br /> SIGNATURE� ' REGIS7ERED , ., . Y../ N: .ry_.,s,�eE Cu�n: Y.l-N . .
<br /> Addres's` - ' " ' ' - . ' , . � ,� ` , .. Cicense# �. � � _
<br /> OTHBR :' " . - � . � �;"C�}11�PAt+IY ` .� ` �
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<br /> SIGNATURE -. � � �"' �' ' � ` '`REGISTERED'' Y/'N:... � FEE CURitE� Y�/N
<br /> Atldres� ., . >. . License#`� �
<br /> ,,.,. ....., _ � �:..,�,..,�,: ,. 1:.;;�,r.;:.:,,. ... >;:,- . � , . � ,
<br /> ltESIDENT1ALt> : �Attaoh"(2):Plot<P;Ians;:(2)sets-of�8uildingrPlanst'(1j°seEof!Energjr?Fartns;'R=O=W Peririitfor'new'constrvction, "_ '"
<br /> ��,:MlNmumt ten;(�1 p);�wrQrkingydays;,after;submittal`date.:.R`equireil onsite;:Con"§trticdon.Plans';°Stormwate'r'Plans w!Silt'Fence`installed,
<br /> -' � �Sanita"ry'Facilitles&,1�4dumpster;Si#e;Wortc�Permitfo�;subdivisions/large�.proJects.�.:. .;:,;; . -. � { ,. , - `
<br /> GOMM�RCIAl. Attach(3)�complete'sets of'9utltling Platis plus a I:ife Safefy Page;(1}set af Energy Forms.R-Q-W Permit tor neuv conshuctton. �
<br /> . Minimum ten(10)working days'after submittal date. Required onsite,ConstruoUon Plans,Stormwater Plans w/Silt Fence installed,
<br /> Santtary FadiiBes&1 dumpster.Site Work Permit for ail new,projecfs:Ali commerciat•requlrements.must meet comptiance
<br /> SiGN PERIVIlT Attact►"(2)'sets of Eiigirieer.ed-.Plaiis.; - �� �� , '
<br /> "•••PROPERIY SURVEY required for_all NEO;V constructlan.. .
<br /> t ,,.
<br /> Dl�eetlons: -. , -
<br /> FIII out applicadon completely.
<br /> Owner 8�Csantractar slgn back of applicadan,notarized
<br /> if over�2500,a Notice of Commencement is required. {A!C upgrades aver 3T500)
<br /> �.;p a,�t.r.'�•,�
<br /> " P�qent{for the cxintractOr)or Powef of Attomey(fa�Uie owt�e�)woutd be sameone with notarized letter from owner authariztng same
<br /> OVER tHE COUFiTER.PERMi1"fiNG- -- •(Front of-AppticaUon Glnly}- -
<br /> Reroofs If shingles Sewers Servlce Upgrades A(C Fences{PlotlSurveylFootage)
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<br /> Driveways-Not aver Caunter if on pubtia roaduvays..needs RG1W
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