|
a�3asaoo2o City of Zephyrhills Permit Application �eX e�a-78p-0021
<br /> � Building Department �_._..
<br /> �\
<br /> Date Received �� �jj -"t�, : ;phone:Contacl:forPecm(ttln . �� _ l ~
<br /> Owner'�Name -i i , i�� /�� Qwner Phone Number 3 �-- � ��
<br /> � (3-Oc�� ~�-I^'�1 �A,.'�^! �VC- `��1 ��Gwe�Phoa"s Pturtaber � �
<br /> Ownsr's Address � � �
<br /> Fee Slmple Tltleholder.Name � � �� Owrner Phone'Number '� ' �
<br /> Fes Stmplg Tltl+�holder Address
<br /> JOB ADDRE33 r� `�('I ( ,E'� Y-�'�.� �E'_ �� �Y ° C `� LO7# �
<br /> SUBDiViStON ��� � P.ARCEL 1D# " t�`"�b"'�f —ts�t 0—r.��j (sp --�t�5`/
<br /> . , , {08TAINED FROM PRGPERTY,TAX�lOStCE)
<br /> WQRK PROPOS�Q ••+NEW-CONS'1'R� ADD/Atl' [^�" 8lGN [,� -[� DEMO�lBH
<br /> , .�, INST�►LL. �� �; REPAIR
<br /> PROPOSED>US� „ Q• SFR - C] COMM' � •OTHER' '• �- �
<br /> TYPE OF CONBTRUC'1"ION Q� "BLOCEC " � FRAME ��� ;STEEC Q
<br /> ��
<br /> pESCRIPTION OF WORK `^� I�` T�''1 r `' l C}?C ,� ��-�� � �` t
<br /> BllIi.DING°SIZ�_ ���x t� �''84�FOOi'AGE���: ...H�1C,FiT`•��
<br /> QBUILDING $ �,/ ��y'� ' VAi,UAT10N`OF�TL1TPiL:�CCth18'FRF7CTIOiV�5. +. .
<br /> �„v
<br /> �]�LECTRICAL. $ . , a� AMP SERVlCE Q PROGRE5S ENERGY Q W.R.E.G.
<br /> �v
<br /> OP.LUMBING $ �- �
<br /> ;. �n�� � _ �� �-
<br /> MECHANIG/4l $ ' ' VALUATION OF MECHANICAL INSTALLATIOR9. �
<br /> o �� ; ������
<br /> QGAS [� ROOFING ;Q SPECIALTY �._] OTHER � �
<br /> �
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES. NO ����
<br /> 8UlLDER J —. —.����,? COMP'i4Nlf=� � �
<br /> StGNATURE ' R��isrer�n Y/ N FEE CURRE� Y
<br /> r--.
<br /> Addres� g �i.� 1� ''" �.�= � � Llcense# � �
<br /> , �... . - .. .
<br /> ELEGIRIClAN• , .. - � ° t:;COMPAM! - ' :
<br /> SiGNATURE � REGISTEREp Y/ N FEE�CURREf�`•t �" '�Y/N � '
<br /> ,; , �`''�
<br /> Acldre�$. .. , . . , - ' ` , , License:# 1:� • . . K �
<br /> PLUMBEIt ` . . • - } ; C.4i�JPANY ,,... .
<br /> SIGNATU�tE'" ' ` _ '.REGISTERED. Y,/.N. _FEE CURRE� � Y,/N
<br /> �ti ��_ .. .. ..,.��
<br /> Adt1r888 , , � LlCeri$8.#
<br /> 11�ECHAPIICAL` .. , ' : _ COMP�WY � .t.• ' ,
<br /> SIGNATURE , - `� , .� - - - , � _ ` 4 RE�ISTERED; Y,./.N FEE:CurtRE�. Y.hN,
<br /> , ` . _ . : •:r a�; , � . .. i ;�., :, _ �- �
<br /> Address:. �f - ' °. ,`.` � ! � ` , . . � - - Ucen$e#
<br /> t . . . . � _ �. � .. .. � L. ,� .,. � ., ,f �G�:.:. _ .
<br /> aTHe� �; ek:;:� .� ;n .. . - . -��;CGlMP/�NY '. � . ,� ��•. � .�
<br /> ,-- �.�.,.. f.r ��
<br /> SIGNATURE, •�:r` �?J `' '.'. 4 ..." , ' ` `t REGI$TERED" .. Y/ N.�._ �FEE CURREA � Y/N
<br /> ie►ddtess�. 'S�.°��c�,���: �� :%,'-'!�:�'� ,1f�-:., „"`�,I� � � �Licsiise#'^� ` �
<br /> . . ,g�, � .:,. . �^e.�it`,r'.,i,-� �S-?.i:,x:.+• . r: . '� .. ,k. . . ,-�t �, - - � -
<br /> �.r � . .
<br /> RESIpEN7'1�1L;;;"`;Attacfi"(2),PlotrPlan's;,;{2)sets��of:8uil'dingiPlans;'(7•)setof=En'ergyy�'oiins,R=�=VY'Peii»ltfa"rnew:ainshuc#lan, - ' ,"
<br /> _,�y ;MinimumjtenY(,10)�woricing;;days�,after;;submittal`date�:Requlre`d anslte;iConstnicBori?Plans;'Stoi�mwater'Plans-w/SIIt Fence installed,
<br /> � `�Sanit�ry Fadtt�es;&1�durripster-,Site�Work:Permifi,#or,subdivisloiis�ierge projects;�y.�;;;:k.t - .. _ �
<br /> - C�]M[4'lERCl� �.tts�t{3)`coiiiplete sets�f'�i�lldfog Plans plus�a�Ife Safefy P�sge;(1}sei of Eiiergy Forms.R-O-W Permltfor new constn�cUon.
<br /> ` Minimum ten(10)working deys�after submikkal date, Required ansite,Cons4rucNon Plans,Stormwater Plans w/Silt Fence Installed,
<br /> Sanitary Facilities 81 dumpster.Site Wortc Permit for ail new�project's::141t cammerctat rsqulrements.must meat campliance
<br /> �SfGt+!PEiZflIlIT Attacti"(2)°sets ofEiigirieisieduPlans:�:�,-��^==.= ',;;y�:;��._. . - .. '
<br /> •,"•PROPERTY SURVEY required,fa�all_NEW,.c:on_s,Wc,Uon...... _ _ - �
<br /> _�Dlrecttons: , :_..,,...;$.-z�� ..r. ' '
<br /> Ffll out applica8on completely.
<br /> I Ownar&Cantractor sign back of appitcaUon.natarized ` „ -- -` ^ .M
<br /> if ovsr�.2500,a t�otice af Cammencament is requtrad. (AlC upgrades aver 57500j
<br /> .. -:,,�:�:,�:-r�,;.;.�
<br /> t°�gent(for the'conVac�oi}or Povirer'of Attomey(Por the owner)would tie someo�e wltti not�rized letter from owner authwizing same
<br /> DVER TFlE COtlN.T,ER.PERNtIT'61NG._.._...;_.{Front of AppticeBomOnlyj_,.._...•. � �.
<br /> -Reroafs If shingles 3ewers Service Upgrades A/C Fences(PiatlSurvey�Footage)
<br /> s;>.. . -_ ._ _ _ r . _ ..
<br /> Driveways-Rlot over Geunter if an pubtic roadways::need"s ROW
<br /> �.--�-- �":�;�r
<br />
|