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a,�3aso-c,�zo City of Zephyrhills Permit Application Fax 813-780-0021
<br /> Building Departrnent . '`'
<br /> Date Recelved , J Z—p7— 20I 'y�
<br /> Phone Contact�for Perrrilttin g/3 �O .� _ 2 C�/S�
<br /> Owner's Name ���$ ��+�"1���-+.�� Owner Phone Number ��� /�� � 6�d
<br /> Owner's Ad'dress 5���' / St • z'P�� � 3���2-. Owner Phone Number -
<br /> Fee Simple sTitleholder Name ` ���2� ����no��,r� Owner Phone Number �
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<br /> Fee Simple,Titleholder Address 51�� 1�� S't � � � `3 3`�� Z-'
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<br /> JOB ADDRESS Jr I k=G /��� 5�' `Z sEp��'Yt- � C� �3.��Z LOT# �
<br /> SUBDIVISION � PARCEL ID# '
<br /> (OBTAINED FROM PRCPERTX TAX NOTICE)
<br /> WORK PROPOSED NEW CONS7R ADD/ALT Q' SIGN� Q �Q DEMOCISH
<br /> e. INSTALL B , REPAIR
<br /> PROPOSED.USE • � Q SFR, Q COMM Q •OTHER ' � ' ' �
<br /> TYPE OF CONSTRUCTION Q` BLOCK " Q FRAME Q STEEC Q
<br /> DESCRIPTION OF WORK�` ���'^� c � e"�-' /�'e �J •
<br /> BUILDING SIZE �J�- SCl FOOTAGE � ��0 . . � ��'
<br /> � ,.HEIGHT
<br /> QBUILDING $ . , . � .. �
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<br /> , VALUATION�OF TOTAL"CONSI`RUCTION
<br /> �ELECTRICAL $ ' � - AMP SERVICE - Q PROGRESS ENERGY Q W.R.E.C.
<br /> OPLUMBING� $ ' '
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<br /> QMECHANICAL $ ' VALOATION OF'MECHANICAC INSTALLATION ,
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<br /> QC�4S Q ROOFING .Q SPECIALTY; Q =� OTHER . � '
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES ,NO
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<br /> BUILDER { COMPANY=� � ' - ' ' '
<br /> SIGNATURE REGISTERED Y/ N .- FEE CURRE� Y/N
<br /> Address - Cicense# ' —1
<br /> 1, _ . � � .����t. �`J�i�-s' � LL�
<br /> ELECTRICIi4N: , COMPANY
<br /> SIGNATURE � REGISTERED Y/ N FEE CURRE�'` ' � Y/N
<br /> Address ' � - , License.# .,L�C l3d07,��� �
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<br /> PLUMBER� COINPANY � •
<br /> SIGNATURE' ' _ �REGIS.TERED� , Y./�N• ' .�(-rFEE CURRE� ` Y/N � -
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<br /> Addre�s . , :License.# � �.
<br /> MECHANICAL`� , . COMP,,ANY - , - ' . . - - .. _
<br /> SIGNATURE REGISTERED �� ..Y,/.N.. � FEEfCURRE�.� ,Y/=iV . �
<br /> + I _ ' 4' :'.p1F � . -. . , .-. .
<br /> Address° - � � " ' • .' ._� � License# -
<br /> E , ' _
<br /> OTHER ` �`;CbMPAWY_ _; � -� - . ' • -
<br /> SIGNATURE . ^ REGISTERED ' ' ` " Y/ N... FEE CURRE� Y/N _
<br /> Addre�s � , , , , - .� ``Cicense#� ' ' � .
<br /> RESIDENTI�►L•.�= Atta;cfi(2);PIot-Plans;;(2)'sets-of�Buililing'Plan"s;'(1)'setof�Energy�Fo'rms��R=O=W'Perrril4�farnewconstruction,,
<br /> _ = Mlnimum�ten;(:1.0):wo,rking;days;after;submittal'date:':Requlred onsite;Constiucdon:Plans';Stormwater'Plans w/S(It'Fence installed,
<br /> � �Sanf4aryFacllfdes:&-1�dumpste_r,_9Site•Worlc:Permitfor'sutiiiiyisions/lafge�projects;- �� � ` �- � � " � � -
<br /> COMMERCIAL Attach 3�eom lete sefs ofBuildin Plans �lus a Life Safe Pa e; 1 set of Ene Forms.R-O-W Permit for new construcUon. �
<br /> � ) P 9 P tY 9 � ) r9y
<br /> Minimum ten(10)wrorking days after submittal date. Requtred onsite,Constructlon Pians,Stortnwater Plans w/Sllt Fence installed, ,
<br /> Sanitary FaciliUes 8 1 dumpster.Site Work Pertnit for ail new<projects:,All commercial requlrements,.must meet compliance
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<br /> SIGN PERMIT Attacli�(2)"sets of Engfneered Plaris:;��.� �---�' ' -' -
<br /> ""PROPERIY SURVEY reguired for all NEW construcUon.
<br /> Directlons:. ° � • ` '
<br /> Fill out applicatlon completely.
<br /> Owner�8 Contractor sign back of appl(catlon,notarized
<br /> If over 52500,a Notice of Commencement is requlred. (AIC upgrades over�7500) .
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<br /> " Agent(for the contractor)or`Povirer of Attomey(for tlie owner)would be someone with�notarized letter from owner authorizing same
<br /> �VER THE,COUNTER.PERMITTING •(Front of�Application Only)- '
<br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage) _
<br /> Drivewaya-Not over Counter if on public roadways.,needs ROW,
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