|
e1s-�so-oo2o City of Zephyrl�ilis Permit Application Fax-813-780-0021
<br /> ' Building Department �
<br /> Date Received ,,.�. _�f
<br /> �-r��--�--r-�- PhoneContactforPermitting `"'� "�"�r`�'"''G7�"o��'� � � �`� G'��•���
<br /> _ �
<br /> Owner's Name � � � � �. a � �. Owner Phone Num6er _ ,�L��l', � �,?(�, �
<br /> Owner's Address ���Q�����e �c� �r �,.� �'��,����j� '`�2-
<br /> � �Owner Phone Number
<br />. Fee Simple Titleholder Name �G� ,-,�. ,�
<br /> Owner Phone Number
<br /> Fee Simple Titleholder Address �
<br /> .
<br /> JOB ADDRESS Q ����,� � ` � �' ,� �Yl���� � LOT# ��� �
<br /> SUBDIVISION S�i l 1�•�r'� �� PARCEL ID# � -r F.,�' � /--� � .s L I'
<br /> �� � � (" �� E�� �"/�
<br /> (OBTAINED FROM PROPERTY TAX NOTICE) �
<br /> WOFiK PFiOPOSED , e NEW CONSTR ADD/ALT � 51GN � � DEMOLISH
<br /> ' 'INSTALL e REPAIR
<br /> FROPOSED USE . �� SFR � COMM � OTHER
<br /> IYPE OF CO.NSTRUCTION ��' BLOCK � FRAME � STEEL � • �
<br /> DESCRIPTION OF WORK -�
<br /> � ��/7 L�[»f�,r r...��r���y =�/'����.r", -
<br /> BUILDING 51ZE SQ FOOTAGE ��� �
<br /> �-re-rr-�-r-rr-.�-r-o-,�-�-�m_ HEIGHT �
<br /> r-r-,�-e-P�-r-�-rr-r-Q-y-t-r-�-�-r�s-rve-r�-e-r-9-s-�-e-e-9-Q-�e-Q-�e--o-�-�-�
<br /> �BUILDING � G �g
<br /> ��d�• VALUATION OF TOTAL CONSTRUCTION
<br /> �ELECTRICAL $ AMP SERVICE
<br /> 0 PROGRESS ENERGY � W.R.E.0
<br /> �PLUMBING �
<br />� �� I � I
<br /> C]MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION �
<br /> 4GAS � ROOFING � SPECIALTY � OTHER �
<br /> FINISFIED FLOOR ELEVATIONS
<br /> FLOOD ZONE AREA �YES NO
<br /> "4--a-�-�I-0-1--0--i-F-4--a=F�-.i-6-3--Q-�-6--i--a-F-B--b-�-v�-6�i-�r-P-G-�B-�--6-v--a--: o-� I1
<br /> �;-�-�,-:--a-.a.-s-�b-a-o-:-o--�¢,�r-:--�--e-a-�-eT
<br /> 6UILDER •
<br /> SIGNATURE � �� - •'��' COMPANY �. � _ �;-, �-J,.��-�.�,.� �"1.L�
<br /> REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address f��[�v� /���<O .� ,� �^ lGrr� �.-
<br /> • License# ���G.��j C:� �, ;� '
<br /> �LECTRICIA�V ���I� � �* ,
<br />, SIGNATURE .,,� � COMPANY �� �,�j?,C)n�,�"',Q',,� ������^�, �
<br /> . • REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address 4�d.��J�F����'"L� �`� � ��
<br /> �' Lfcense# ���,����,J���,�
<br /> PLUMBER �
<br /> SIGNATURE ,..�`✓d' � — MPANY ' � / ` �,(�,�` . •..+,f' • 't�,�!�',c�,�F,,,� ' �
<br /> << �
<br /> REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address
<br /> t��� �- �, �a _ — ---_ � __ ,�
<br /> MECHANICAL �
<br /> SIGNA7URE "a '" COMPA �, - �, � ��
<br /> �-�T��' �— �REOISTERED , n �
<br /> _ Y�`/ N FEE CURRE� . Y/N
<br /> Address � ,,,
<br /> .,G�• �
<br />, _ � License# � �
<br /> OTHER � ,..r�
<br /> SIGNATURE �� ~ : -' ,- - ` _..--.�- � N_ ��_ .
<br /> - . „--.�F.✓-/; ;�.;:�- ;� ,. .. .
<br /> REGISTERED Y/ N FEE CURRE� Y/N ' �
<br /> Address � , .
<br /> �� ��� '�'���`� Licerise#
<br /> 1 1 1 1 1 1 1 1 1' 1 1 1 1 OtI l 1 1 1 1 0 1 1 1 D 1 1 1 1 1 f I I f 9 B 9 ➢ I O ! 1 1 1 1 1 1 1 9 0 .1 ➢ i p ! 0 9 9 9 p ! B 0 0 1
<br /> RESIDENTIAL Attach (2) Plot Plans; (2)sets of Buildin g P l a n s; (1)s e t o f E n e r g y F o r m s; R-O-W Permit.for new construction, � �
<br /> M f n i mum 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 f6r subdivisfons/large proJects
<br /> COMMERCIAL Attach (2)complete sefs of Building Plans plus a Life Safety Page; (1)set of Energy Forms. R-O-W Permit for new constructfon.
<br /> Minimum ten (-I o)tvorking days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
<br /> Sanitary Facll)ties &1 dumpster Site 1Nork Permit for all new proJects.All commercial requirements must meet compliance
<br /> SfGN PERMIT Attach (2)sets of Engineered Plans.
<br /> '�`""'FPROPER7Y�5URVEY required for all NEW construction,
<br /> Di�'re ti�O s-�--0--e..�_I'a'a"L"�'-�-0-8--C-1-�_
<br /> FIII out appifcation completely. �������_�����y'�`����'-&-�--�4�8�-1��..
<br /> Owner�,Contractor sign back of application,notarized
<br /> IP over$250D,a Notice of Commencement is required. (A/C upgr.ades over$7500)
<br /> "` Agent(for tlie contractor)or PoWer of Attorney(for the owner)would be someone with notarized letter from owner authorizing same
<br /> IVER THE COUNTER PERMITTINC
<br /> 3eroofs if shingles Sewers �copy of contract required)
<br /> :;ervice Upgrades A/C Fences (Plot/Survey/Footage)
<br /> Driveways-Not over Counter if on�ublic roadways..rieeds ROW , � . , . , , �
<br /> I ' ,
<br />
|