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�e13-780-0020 Ci of Ze h hills Permit A licatian Fax 813-780-0021
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<br /> • , Buttding�Department � '`
<br /> Date Received Phane�Contac#for Permtttln
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<br /> Owner's Name , p �-.� Owner Phone Namber
<br /> Owner's Address 3 7��Q �'���� �,.J P�;,. Owner Phone Number
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<br /> a �Fee Slmple;Titlefioider Name �� �� Qwner Phone Number '�
<br /> Fee Stmple�Titleholder Address •
<br /> J08 ADDRESB �7�''�� � P` LQT# �`____�
<br /> SUBDIVISIOPt �� � PARCEL IQ# ��"�o'a� �--9�'z.�3�- E�c9��-- GP c�`�
<br /> � (OBTAINED FROM,PROPERTY,TAX NOTICE)
<br /> WQRK Pt2QPOSED :NEW CO(�STR . ADDIA�T �` SICaN' -Q � � Q DEMtJLISN
<br /> y , --e. INSTAl.L 8 ; REPAIR � .
<br /> PRQPQSED��USE Q SFR, �] �COMM '- 'Q -0THER �" ,
<br /> TYPE OF CONSTRUCTIQN Q� BLOCK " �Q FRAME � STEEL 'Q
<br /> DESCRIPTION CtF WORK � � .��-Z_
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<br /> BUlCDlN6 SlZE' �' �' SQ FOOTAGE`���, ,HEIGH'f��E� �
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<br /> �g���1Ne'' � `� VALUATICIN:OF`'t'ClT,4L CONS'fRUCI'IO1V y
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<br /> QEIECTRiCAL $ - ��� AMP SERVICE Q PRO�FtESS ENERGY Q W.R.E:C.
<br /> QPLUMBING $ - �� �
<br /> ��� Vv
<br /> [�MECNANICAL $ VAl,OATION OF MEGHPWIGAL liVSTAL1.ATiON �� ��,�a �,�I�
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<br /> QGAS � ROOFING ;� SPEGIALTY � : OTHER� t./" GCi'�
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<br /> F�WISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES. NO
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<br /> BUII.DER , CUMFietNY' . .. .� .
<br /> SIGNATURE REGISTERED Y/ N FEE CURRE� ' Y'/N"
<br /> A�3dres� - ` Ctcense#"� �
<br /> ElECTRICIAt�!!. COMPANY
<br /> SIGNATURE � REGISTEREp Y/ N FEE CURRE�'' �•Y/N
<br /> t} � '� � �"�'"�'"
<br /> Add�e`ss ` , , - ,Llcense# { .-„ �
<br /> PLUMBER� ,>COMPANY , ' .
<br /> SiGNAYURE� ' '' � �REGISTERED ,Y/,.N,� t-;FEE;CURRE� � ' Y-/N �
<br /> AddreSs - _I.�CeAsB.# �� � � �.
<br /> MECHANlCAL � . , „ } G.QMPANY _ � „
<br /> StGNATiJRE • ' ' � �GISTER�p. � Y./ N` `'_ � FEECURRE�-. Y./rN •
<br /> Addre�s� , .. . ` ` , . . '_ - �icense# � �
<br /> QTNER � _ � �
<br /> '` �GC?MPANY .
<br /> S1GiNATURE �. ' ' " -R�GISTERED�' ' Y/ N,. � Fee Cuw�n Y/N
<br /> Address 2`�7�$i°= ,ll ct�.�,��; ��' GErerise# �C�'-�� �.�,.'�"2-� .
<br /> -��.�... �..._;,,,;. .. �, -, • _ r;`_..,.., : .. .
<br /> RESiDENTlAL,;.: �Attach(2j.,Plot<Pla�s;.(2}sets�ofBuiti!li�g�Plarts;'(1)set'of-Energy=Fori»s;R-0iWPeiitiitfarnawconsbuc.#ion,., .
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<br /> -:�- •Minimum�ten°(1A,);vuarking;d"ay�:atter;submittaliiste:'�Reguired onsite;Constiuctlon�Plans;Starmwater'Piens w/Sfit�Fence installed,
<br /> ,~_�, Sanitary'Fac(Itties:&1*.,,d.umpste,r,i3lte�..Work�P,ertnit;for.subdivlslons/large;pru)scts-.,_;�,:;.� " � '= ' `` " - • �
<br /> COlIRN1ERCIAL Attach(3j�coiiiptete sets"bf`Bullding Plaiis pius"a Life Safeiy F'age;{'1}set of Energy Forms.R-O-W Permit far new aonstructton.
<br /> Minimum ten(10)working days'after submlttai date. Required onsite,ConsUucBon Plans,Stortnwater Pians w/Silt Fence installed,
<br /> Sanitary Facilides 81 dumpster.Site Work Permit for all new�pro)ects:All commerGal requlnements,must meet compllance � �
<br /> SIGN RERMlT Attac6'{2)sets ot�Eiig�iieered;Plans:f�� ,���= : -. `.. , �
<br /> ""`PROPERTY SURVEY regufred for all NEW,c:onshuctlon..
<br /> Directian�: _. � - .. .. .. ...
<br /> Ftll out application wmpletely.
<br /> Owner 8 Contractor sign back of applicatlon,noNarized
<br /> If aver�2500,a Notice.af Commencem�nt Is requlred. {AtC upgrades aver�7540}
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<br /> '" Agent(for tFie co�tracttir)or Pow`e�of'Attomey(for tFie owne�)would be someone with'notarized letter from owner authorizing same
<br /> DVER THE COUNT�R.PERM17TfNG. ...._;..{Frontof-Appllcattan Oniy) - • . �
<br /> Reraafs if shingles Sewers Service Upgrades A/C Fences(PlobSurvey/Faotage)
<br /> Drivewaya-l+tat aver Caunter if on pubtic roaduVays..iieed's RG3Vtt � �
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