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<br /> s�saso-oozo Ci4y ofi Zephyrhills f'ermit Applicafiion Fax 813-780-0021
<br /> Building Department
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<br /> Date Received � pp�ane Con4act for PermigQing �a� 3 � ��-- __ C��,�-�
<br /> Owner's Pdame � �. W�t�h ��'�,5����- t J�1 ��/1�, Owner Phone i�umber ���— `��-���°F"�
<br /> Owner's Address �y ��� ��L �� �Q � �����S ��. �`��f� Owner Phone Plumber
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<br /> F�e Simple�Titleholder Name� Owner��one fVuenb�r
<br /> , ,.
<br /> Fee Simple Yitleholder Address
<br /> JOB ADDRESS � �{1 LOY# ��
<br /> SUBDIVISIOW � !'i G�..�O�G� Pr4RCEL ID# �o�' �� '' �1—D`��c� -- o�c�p-��c�D
<br /> , (OBTAINED FROM PROPERN T/llC fVOTICE)
<br /> WORK PROPOSED ? NEW CONSTR ADD/ALT � SIGN Q � 0 DEMOLISH
<br /> j � INSTALL e REPAIR
<br /> Pt20POSED USE � Q� SFR Q COMM � OTHER
<br /> YYPE OF COPdSTRUCTIOPd } Q�` BLOCK - Q FRAME � STEEL Q
<br /> DESCRIPTIOiV OF WORK f ��� ����'t��-C�-:u 1� '— � `��•�-'�' '
<br /> �UILDING SIZE � SQ FOOT,4(s� 1�'� b� �p��G�pY �' ,
<br /> �BUILDING ; $ G� � I ��t? VALUATION'OFTOTALCONSTRUCTION
<br /> 1
<br /> DELECI'RICAL $ AMP SERVICE 0 PROGRESS EIVERGY Q W.R.E.C.
<br /> �PLUMBING $ �� ���
<br /> l .�� cJ
<br /> OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION � �5�� ��/�P �Ir'
<br /> �, �.o,ey
<br /> OGAS Q ROOFING Q SPECIALTY � OTHER �1 "�,Qo„� G��f�Y�'�
<br /> N�x.ri�
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES NO
<br /> BUILDE9a COiiIIIiPR,f�V �0 ��.✓1 �(�a`a.��--s�(;�'�-��V� ���-
<br /> SIC9iUAYl7R� - REGISTERED Y N FEE CURRE� Y/nJ
<br /> Atic�ress � �7a ��. ,j ✓�1��ts 3`3�J�� License# ��?C �.� � � ��f
<br /> ELECi'@21CIAN COMP�4V�Y �dS� �G.SCC:� �`��,��"l�
<br /> SIGWATURE REGISTERED Y/ N FEE CURRE� Y/N
<br /> �4ddress 1��./`51�� s �l License# �. i 3 c�o � o�
<br /> PLUfVl�E�i COPd1P�4i�Y -J �iS ��lR,�^^�i ✓�-s
<br /> SIGY11A7�URE REGISTERED Y/ N FEE CURRE� rJ
<br /> Address License#
<br /> BlIECH�AitIIC�AL COY11iPAP�Y �C� Y�'11�.� � ��C..
<br /> SIGiVATURE REGISTERED Y/ IV FEE CURREA Y/N
<br /> Acldress License#
<br /> OTHER COMPANY �'�'��- OF�
<br /> SIGfd�Q°CUF2E_, REGISTERED / N FEECURRE�' �J
<br /> �,adress " G N l�, S� .5`if 2,e �h;l� �(�?��S �� �icense# G�G(7i � J J`�'CJJ`—
<br /> RE�IDEft11;lAL •; Attach�.(2)`:Piof'Flans;:(2):sets•of�Building�Plans;�(.1)seYof Energy Forms;R-O-W.Permit for new.construction,
<br /> Minimum:tent(;10)working!days after.subinittal:iiafe. Required onsite,'Construction Plans,S'tbr.mwater Plans w/Silt Fence installed,
<br /> Sanita.ry..;Facilities�.&,1�.dumpste�;S„ite:W.ork Permit forsutidivisions/large projects • �
<br /> COMMERCIRl. Attach(2)coinplete sets of Building Plans plus a Life Safe,ty Page;(1)set of Energy Forms.R-O-W Permit for new construction.
<br /> Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
<br /> Sanitary Facilities&1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance I
<br /> SIGhV PERiViI'f Attach(2)sets of Engineered Plans. - �
<br /> "*""PROPERTY SURVEY required for all NEW construction.
<br /> Directions: ,
<br /> Fill out application completely.,
<br /> Owner&Contractor sign back of application,notarized
<br /> I#over$2500,a Plotice of,Commencement is recyuired. (RJC upgratles over$7500)
<br /> "" Agent(for the contractor)�orPower of Attorney(for'the owner)would be someone with notarized letter from owner authorizing same
<br /> OVER TF9E COU�lTER PERII(!I'P�PIV�G (copy,of contract required) _ . - ..
<br /> Reroofs if shingles Sewers� ServiGe�Upgfaifes Sf1/C- Fences(Plot/Survey/Footage) � �
<br /> Driveways-Not over Counter if on'pu6lic`�oadways:.needs R01N, , , .. - , -
<br /> �r'�. r. .� , , , , , , ;
<br /> � ., , �'f. �i5' . , ., ,� . �, - • - ., . _ . , .- -
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