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<br /> a�a-780-0020 ; Cify of Z�phyrhills P�rmit Applic�fiion Fax-813-780-0021
<br /> • , Buiiding Depaciment
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<br /> D�4e l2eceiv�d . . �� �(q t � 1�han�Coofiacfi.ficiP��rm3ggi�t�- � t� �U� --t.p� l
<br /> Owner's�larnm, �("�"��U� V Ouvn�t�Q�one P9tami�er t../ `� t ( .. • � 'T
<br /> Owne'r's Atic9r�ss. 1� � b� l�� �V I( 4J�(Own�r Phone P9urrak��r �� ��
<br /> Fee Simpl�1'ikleG�older'iUam� �w��p p�¢�,�¢���q��q��P �� �
<br /> Fee�^imple Y6tleholder.4c9t9r�ss
<br /> Jo��,nn�a��s ' � (�(� n �- ( ►��S �� �f v�� c.or� �_�
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<br /> SUBp9Vl�tOt� [ I ������«� C� � �-a�.-��c.� --600c� ��f �a
<br /> (OBTAINED FRCy1N�PROP�I2TY TA7C PfOTICE)
<br /> 11i�0�9��R09�Q�ED � NEW CONSTR Ad�IACT � SIGR! �]r � Q DEiVfOLiSH `
<br /> I e IfVSTAL,L 8 •REPAIR
<br /> ��OIPQS�Q USE � Q SFR Q C4MI�f �� OTNER
<br /> YV�E'bF COP�STIdUCYIOPI i Q BLOCK • [,� FRAME � STEEL Q "
<br /> ��sc���Tia�oF.wo�ar� i ,� S uC�!'�S ��"� �l/�'t jl� C�5 �(1C�.1�' � i�t��e3 l,U i`�-�/1 C�.
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<br /> �u«:�e��s�z� ��� �� �c��oo�r����� ��i��ov �� � U��.�((Gt,� ►�V1�
<br /> �8Lt1LDt�tG ' $ VALUAT(ON't7F TOTAL GONSTRUCTtOiV � Y
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<br /> �EE.ECTFtiCAt � � A11AP SERVICE � PROGF2ESS Ei�EFtGY Q `Vi1.R.E.G.
<br /> QPLUM81i�lC'a , � � -
<br /> �MECElA�VlCAL ! $ VA�UAT1Q�i OF MECHAI�IGAL'1�4STALEATIQN '�"� �� L�-' - _.
<br /> QGAS ' Q ROQFII�G Q SPECIAI.TY � flTNER �'��
<br /> FIRlISHED FLOOR ELEVATIOiVS ��� FLOOD ZOfVE NREA [�YES NO
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<br /> �U[�.�EQa C06UdPd�N&Y
<br /> SICvi��aYUR� REGIS7EREp Y/ N . FEE CURREA Y/IV '
<br /> a4t�o7o��s� -Lieense# �� �
<br /> ELECS'RIGI,AYd �Lifll�P�A�9Y
<br /> SIGfNi�7lJF�E REGISTERED Y 7 N FEE CUftRE� Y/N
<br /> ,�ddr�s� Cicense# � �
<br /> ��.ur����. co��,�v�. . .
<br /> $IGI�A'TID�� REGISTERED Y•/'N- � FEE CURREA Y PN
<br /> ,qddP�ss � License# � �
<br /> 6ifl{EC6�6,�i3iC�t: � ; , CO�ili9�AP�Y
<br /> $9GR�IIA'TURE` � REC�I5TERED Y/ fV , FEE CURRE� Y/N
<br /> Adi�eess�� License.# � �
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<br /> o�w�t�- ' co�nw��v �c.(1 b0 r C
<br /> SIGPBI�'�lOF3�.� �i i REGISTERED / RI FEE CUR � ./N
<br /> l�C$C�P�58' �� � 1 1 1~��� �I License# ��l J at c.1��J-�
<br /> RE�IP?�I�T�A�:;_f` A,ffaclia{Z};P�otPlans;�:�2)>�et's�of�BuiEding?P.Cans;:(1)'set�af'Energy:Fa'r'ins;'�-,0-1N:Permit,for new.canstrucfion,
<br /> �:Mlnirnurrr,rt�n,(1'Q)yv,grkingl�days�afte�-submittal�d�te. Requirecl�onsite�'Construckion Plans,Stor,rrrwater Plans w/Silt Fence installed,
<br /> H. i� •♦Y�. .SanitaS.y:.;F,�acilities�%&�;14dumpstei; ,S.,ite� .W.ork'Percn'it for:'sulidi'vi5ians/targe.proJects�
<br /> �03if1�t1ERC1A9. A#tachu{2)'c4rriptete'sets ofif Buitcling Plana ptus a�ife Safery Page;(1}se#of Energy Forms.R-O-UU Fermit for new consfruc#ian.
<br /> Minimum ten(10)woricing days after submittal da#e. Requi�ed`onsite,Construction Plans,Stormwater Pians w/Silt Fence installed,
<br /> Sanitary Facillties&1 dumpster.5ite Wartc Permlt fof•all•new pra�ects.Ail commercia!requirements must meet Comptiance
<br /> •S1�Ri�'�9�i�t1" ;4#facFi(2}set's qf�Engineered Ptans �
<br /> �°**"PRORERTY SURUEY requited foc.all,fVEW.canstructian.
<br /> t3ir�c�ions: , � �
<br /> Fill:out application campletely.
<br /> Owner&Gontraetorsign.back af•applicatian,notar�zed
<br /> 1�:ovea��2500,a�ogic�sr I�omm�ric�cvt�e�t is e��uiPmt9. ��4/C u��rac�es ov�sr�77900)
<br /> *" Agent(for'the°cont�actor)�orPowerof AttoPney(fbr'the ovirner)wauld tie someone with notarized letter from owner authorizing same
<br /> OU�i3''fF�E�C,SJ69�1'i�F2:,�?�R�ttii 1'�':'�'16�C�, (copy.of-contrac#�required} �
<br /> Reroofs if shingles Sewers� Service Upgrades AJC Fences(PIot/Survey/Footage)
<br /> -__�_briveduays=Not ovei;Gountet ifi ori puh(iu�,�oadiruays..needs ROVt/ • - _�~ 1:,��� , � _ , �-f- .-^e. _ �- N �
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