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a��-7eo-ooao �City of Zephyrhitls Pe�mit Applica�on Fax-813-780-OQ2'1 <br /> Bu!lding bepartm�nt <br /> Date Reaelved ' � Phan�Cant�tct for P�rmittln �� "t�� — �S� b <br /> Owner's Name l�� 1� �(JI� �' ��� Owner Phane Number <br /> Ouuner's Address - Owrner Phone�Nurnber { 1 ; <br /> Fee Simple Titt�hold�r IVffime �!�! � Ovsmer Phoa�Plumber � � <br /> Fee Sfm�lg Tltlehalder Address <br /> JOB ADC►R��3 Ul�� GLIi��I� �• 4.�T# ��,� I <br /> : <br /> �u��i�is�o� c�l���V��{,(�.. � par�cE�,ia� Q��a�t9� � -�0�t� 'UO (�0 - t�l�0 , <br /> iaerr�wea�ar�P�ag�nrrruc xaxtcey ; <br /> WORK PROPOS�D , e �avv cot�rnt 8 AODtAtT C�� SiGt� 0 � DEMOUSH i <br /> INSTALL REPAlR ` <br /> PROPO��D.U�E � s�a [� co�n�� � o�c�E� � <br /> nr�e o�co�sr�uc�m� �] B�acK - p ��aMe [,� STEE� p ! <br /> ��scRi��aw aF wo�:� �U t�1 G1-�i i'1 ��1� 1 . <br /> Bt11l.DlAiG�tZE �Q FOOYAGE�� HIEIGt#T C�� , <br /> �BUlLDING �� VALUATIONT3F'fOTfiL COidSTRUCTtON <br /> Q ELECTRICA4. ��'�. � AMP SERVICE � PFtOGI2ESS E�3ERGY Q W.R.E.C, <br /> L.� <br /> OPLUMBING $ l��•�� �� <br /> � � <br /> [�JMECHANICAL $ VALUATION OF MEGHANlCiAL INSTAI.I.ATlQN 1/`" <br /> � <br /> QGAS Q ROOFING Q SPECIALTY [� OTHEFt ' <br /> FINISHED FLOOR ELEVATIqNS � � FLOOD ZONE AREA [�YES NO I <br /> _ � <br /> _ I <br /> BUILC?ER COMP/tPIY � <br /> SICsNI\9'UF3E F2EGISTERED Y/ N FEE GURREN Y/N � <br /> A�dress Ltcense# �� <br /> I <br /> ELECTt2{Cl�N COlUppklt�iy " ; <br /> SIG(t�4TURE �` REGISTERED Y! N FEE CURttEP�• Y!!U ��� I <br /> Addrass License# � <br /> 1 <br /> P�UMBEf3 co���+,v Vc IYY1 � (Q� � <br /> SIGRU0.YURE' REGI$TERED Y./. N FEE CURREN -!Pl <br /> ����� �l! �-h �r► f �- Gi t�/ ��ris�# L-���� <br /> t�ECHARlIC�L C��P�1+[Y ' <br /> Stt�WATt11�E REGISTERED Y! N �cu�2aEn. Y/�1 � <br /> ,�ddre�s License# �� � � <br /> O'TFi�� CQ�tNP�[Y .. <br /> Sli"sFiAlTU13E - REGISTERED Y/ Id:. FEE CURRE� Y/Pl . <br /> Adalress - Ucense# �� � <br /> RESYCI�P6TIA1: Attach(2)PIof.Pians;:(2)sets of Buiiding•Plens;(1)set of Energy•Foims;R=IO-W Perrn3t for new construction. <br /> .Minimum.ten(90}:working;days after submittai date.=.Requtred onslte,CanstivcNon�Plans;Stortnwater Plans w1 Siit Fence installed, <br /> Santtary FacElitles 8.1.,dumpster-Slte Work Permt#for subdtv3stonsltarge projects,_ • <br /> CIJ1WWiE�Cl�4. Attach(3)complete set`s of Buildirig Plans ptus a Ltfe Safety P�ga;{1)set of Energ}r Fortns.R-4-W Permit for new canstruction, <br /> Minimum ten(10)worktng days after submittal dake. Required onsite,Ccrnstructlon Plans,Stormwater Pians w/Sfit Fence installed, <br /> Sanitaty FaclliYies�1 dumpster.Site Work Permit for att new projects.Att cammerciel requirements must meet r�mpiiance ` - <br /> S1GN t�ERNlIT Attach(2)sets of Engineered.Plans. . , - -- - � <br /> "`•PROPERN SURVEY requtr_ed for all NEW aanstrucdon. - ` <br /> Dlrectlons: i <br /> �Ftll out applicaUon completely. � <br /> Owner�Contractar sign back of applicatton,notarized � , <br /> if ov�e$260Q,��fo4�c��g Comm�ae�mee�t 1s reqaired. {�!�upgr�des ovgr$Y�00} <br /> " A.g�t(f�r the c;flntractor)or Power of Attomey(for ttse awner)woutd be someone veith notacized letter from ouuner auttsarizing same <br /> � ��.Tsz�COUt4TER PERAl1TTlAlG {Front af AppiicaUon Only} • <br /> ;��-��:�-�•� Se�.srrers Senrice Upgrades A/C Fences{i'Iot/Survey/Foohage) <br /> ,. - <br /> � .��s-:���-�:�r�i�r,:z.�.:z�:c a�d:vays..needs f20W � <br /> �._ , _ „ . . . � <br />