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a��-,a+1-�,�,�� City af Zephyrhiils Permit Applicatian Fax-a�s-7saoo�� <br /> Building Qepartment <br /> c � <br /> Date Reaeived Phone Contact for Permittln �� ��- - ��� <br /> Owner"�Name f j11�"CQ��571p�Z / �/1 Owner Phone Numbor ���" Q ��� <br /> Owner's Address O��� d T���V'�Od �� Ov+mer Phane Number � � <br /> Fse Slmple 74tleholcler Mame � � Owner Phone Number �— � <br /> Fee Slmpte Tittehalder Addrsss <br /> JOB ADbRESS �S �� 1..�b ' �7�,�G� J L-• GOT# �,,,� <br /> SUBDIViS10N �f21-N`lL�d�f�Q�}' S PARCEL ID# 4� �� a�' � D�`�J ���`�� ���� <br /> (OBTdlNED FROM PROPERTY TAX NOTICE) <br /> WORK PROPQSED , e NEW CONSTR� ADD/ALT � SIGN Q [� DEMOLISH <br /> INSTA�L REPAIR <br /> PRQPOSED.USE Q SFR Q COMM � OTHER <br /> TYPE OF CONSTRUGTiOi+i � BLOCK ' [�J FRAME � STEEL Q <br /> DESCRIPTION OF W4RK ��" � /G� I D7V Q� .(�iD'�1Z 4dJ��-� <br /> BUILDlN�SlZE SQ FOOTaGE Ci_`� HEIGHT [�� <br /> QBUILDMG � �� VALUATtON�`OF TOTAL CONSTRUC710N <br /> QELECTRICAL ($ -- ' �� AMP SERVlCE Q PRC?GRESS ENERGY Q W.R.E.C. <br /> (�� <br /> OPLUMBING �-� ' <br /> [,�MECHANICAL $ �-�� VALUATiON OF MECHAMCAL INSTALlA710N. <br /> QGAS [� ROOFIRfG .Q SPECIALTY Q OTHER <br /> FINISHED FLQOR ELEVATIONS �'} F�OQD ZONE AFtEA QYES NO <br /> � <br /> BUILDER COMPAMY <br /> StGNA7URE REGISTERED Y 1 N FEE CURRE� Y/N <br /> Address Ltcense# � � <br /> ELEC7RtCtl4N � COMPANY <br /> SIGNATURE � }2ECaiSTEREO Y! N �E CURRE� Y/N <br /> Addre�s License# � �� <br /> PLUMBER � GdMPANY <br /> SIGiVA`i'i1RE REC318TEftED Y/ IV FEE CURREP Y/N <br /> Address L(cense# � `� <br /> MECHANICAl. � �1�� � COMPANY t �'D 14 2- � �G'.-=�V�1 � <br /> SIGIV/�'TlIi2E L�`�� J Ciy�l�"` `-C�"'� REGISTERED Y! N FEE GURRER Y/N <br /> Address � � � License# �������� <br /> OTNER ,COMPANY <br /> StGNATURE REGISTERED Y/ N FEE CURREt� Y/{11 <br /> Address Ltcense# �i `�� <br /> RE3lDENTIA!•. Attach°(2).Plof P.lans;(2)sets cf:8ultili"ng`Pians;(1)sef of-Energy Forms;R-tU-W Permlt far new constructian, <br /> Minimum:ten(1.0).worlcing;days.aRer,.submittal date. Requtred onsite,Construc8on-Plans;Stonnwater Plans w/Sllt Fence instaqed, <br /> Sanftary Facilitles.&:1:,du�pster�Site Work:P..ettnit#or sub8ivislons/iarge projects <br /> COMMERCIAL Attach{3)comptete sets of Buitiling Pians pius a tife Safety Page;(1)set of Energy Farms.R-O-W Permit 1`or new construwtion. <br /> Minimum ten(1 Q)woricing days after submittal date. Required onsite,ConsUuctian Pians,Stormwater Plans w!Sllk Fence insta!led, <br /> Santtary FaciEiBes 8�1 dumpster.Site Work Permit for all new projects:AII camrnercial�equlrements must maet comp!lance <br /> 31GN AEFiMIT Rttacii(2}sets of Engineeredrplans. <br /> *'**PROPERI'Y SURIIEY rsquired for atl NEW constructlan. , <br /> Dtr�attons: - <br /> � Fiii aut apptica�on completety. <br /> Owner&Contractor sign back of appllcaBon,natadzed <br /> if over a2S00,a Notice of Commencement Is required. (AIC upgrades over�7500) <br /> '• Agent(for the contraetor)or Power of Attorr�ey�(for ttte awner}wauld ba someone with notarized le#ter fmm owner authorizing same <br /> DVER THE COUNTER PERMiTTING , (Front of Appiicat(on Only) , � _,�.,,,;_. _ <br /> Reroafs if shingles Sewers -Service Upgrades A!C • ferices(PlodSurvey/Footage) � � -� ^ '� ' ' <br /> Drlveways-Not over Counter if on public roadways..needa ROW , , - , � , � <br /> ,,. ' � , <br /> � <br /> 4_____._ _..._._.. . _:__.�_.v w:_- _._ _._�,:.__.r_.�._-.,..:_.=__.� _�.-.�-- --- -.._..__ �___ . < <-,. e..w.,.__.._,..._�.4........ ... <br />