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<br /> 813-�saoo�o City of Zephyrhills Permit Application Fax-B13-780-0021 � �
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<br /> 8uliding Department -
<br /> Date Received �j �"� ...� -�j_.'
<br /> ; yt ;. Phons�CoMact�for,PerntiitEin
<br /> Owner's Name l2 - Owner Phone Number �. — �26 7� .�
<br /> Owner's Address � S� er Phone Number . ��('�(��''��i1 !
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<br /> Fee Simple Tltleholder Name // ' � �.�'� O.wner Phone Nunnber
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<br /> Fee Simple Titleholder Addr�sa L��/� O
<br /> � ' �JOB AQDRESS LOT#
<br /> SUBDiV1SION Rj1RCEl.ID# � ` " I
<br /> ' % , (OBTd4(NEDF,ROlA,PROPERT1f,TAX.NOYICE�
<br /> WORK PR�POSED �NEW CONSTR' ADD/At,T •�� SIGN' �[� ;[� DEMOCiSH
<br /> ; , � e. INSTALL 8 REPAIR � �
<br /> P120POSED<USE Q SFR Q COMM -�.., OTNER. Y ;
<br /> TYPE OF CIdNSTRUCTION' = Q � 'BLOCK ' `�] FRAME '�. 'STEEC Q •• �
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<br /> DESCRIPTION OF WORK I e, (�O G � l
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<br /> �UILDING�SIZE - - � 'SQ FOOTAGE '���; J ,.HEIGHT �� '
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<br /> S,UlLD3Nt'ar , $���'f'��pO uq�,UATION.'fJ`F'7'Ol'AL'�CONSTRII'CTION f � i
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<br /> E�ECTFttGA� $ r� ° AMP SERVIGE. �Q PRQGRESS ENERGY '[�, 'W:R.E.C. '
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<br /> �MECNANtCl1L $ � ' VAi:0i4TtON OFtIVSECF�lA�11CA1 tIdSTALtATIQN
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<br /> Q GAS Q ROOHl+�G .Q •SPECIA�tY.,C�_:. ;OTHER� ���� ' '
<br /> FIfVISHED PLOOR ELEVATIONS ��� FLOOD�ONE AREA .QY�S. .NO , '
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<br /> 8tlH.DER i � t�COMPA►F!Y'= � i (�7 � .,
<br /> SIGNATURE _ Re�iSre�o Y/ FEE cu��` � Y/N . �
<br /> �ddre`ss iG2l� 6 � . S r� License# I� .`f//����(p :J � ��G/
<br /> EtEC't'RlCI�: � }COt4APANY' �
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<br /> SIGNA7URE` �- '' REGISTERED Y/ N FEE CURRE�" ` '�Y/N.. ' !
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<br /> �ddre$s..� , . , . Ucense'#.I,� " . �
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<br /> PLUMBElt r�' , /} � _GOMP,,,ANY , - -. � s :, �� .� , i
<br /> SIGNATUI3E'. /l� � REGISTERED.(c =.Y;/x.N<� ,;FEE�CURREt� ' Y/N. � I
<br /> Addreas ' ` ` ': � . , .�,Ucense7#��� i . �-
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<br /> MECFiRt�ii1CA1:. A` � l/l. ` ' GO�IIPANY � .�a,' ;.`: ,>, � �r.:>;.,;., ' . , I
<br /> SIGNATURE� /� G� ' � REGIS7ERED,,;�� Y,/:N,`^ },FEE CURREp,"_ YxG:N I
<br /> Addrs�s� : - • - � - - . . '' ._ - �_License'#�� � �
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<br /> O'LH�R .° - � _ . � , ;Gt51i,APAWY'` - �� `�- . . -� • - �,
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<br /> SIGNATl1RE� t-;.:. r' . ' � 'REGISTERED�`` - .Y�/ N:_. ' -�"FEE.CURRE� Y/N.
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<br /> Address - - - � - • �Llcense#��' ' ,-� �
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<br /> RESiDENTlAL,�<;::;.Attacti;(2}:Plo#�_Plans«�.(2}se�s=of.�Bulldiiig?;Plaiis;'(1,}��efiof'Energy��dmt,s;R=d=1N�Peiti%if�fbrnew°constructton, , . , .
<br /> -; '�,_�;:Mlnimum;ten(�1.0)�uyo,iking;days,�.aRe rsubmittalilate'uRequfred onslte;.Cohstnictlon`PlansrStormwater�Plans w/Silt'Fence installed; ___'_
<br /> ' ^Santtary F�aclltUesr&1£,dumpate_r.,;�Slte:WorlctPermittor.sutidi.visfons!large'�piojects;.:�,�:�- :�-:">,,:` � : . .
<br /> COMMERCiAL Attach{3}`eomplete-sefs of Buiitling:Plaris pius•a.life�Safety Page;(f}sat of=Energy Forms.R�O 11V PaRn1t for nauv.canstruction.
<br /> Min(mum ten(10)working days�after submittal date. Required onsite,Construcdon Plans,Storrnwater Plans w/Silt Fence Inst�lled,
<br /> S�nitary Fadlides 81 dumpster.81te Wark Permit for aii new,projec�..Ri!commercial regulreme�ts.must meet compitance
<br /> Sl�N PERMi7 Attac.�{2j�'sets�of�Eriginee_r,ed;!?tans:; ,�;:~-;1- :;:">:�. -
<br /> � ""•PROPERIY SURVEY�requi�ed_for all NEW construcUon. • ,
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<br /> Dlrec`tlons: „ -. • , � . , , `. .
<br /> Fill out applicaUan completely. '
<br /> Owner&Contractor stgn back of appiicatEon,natarized ` �
<br /> If over�2500,a Notice of Commenc�ment.is requlred. �(A/C upgrades over 3750p) _
<br /> " Agent(for tiie�aititractor)'orPoWer of"Attomey(fn�ttie owner)would be someone writhLnotarized letter from owner authariiing saine , �
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<br /> DVER THE COUNTER.�ERNfi7'tiNG� , -(Fmnt of-ApPlication;Only).:• . `, ". � . �_ , -
<br /> Reropfs If shingles Sewers Service Upgradas A/G Fences(PIoUSurvey/Foatage)
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<br /> Drlvewaya-Not aver Counter if an public roadways:cneeids'ROW'� � �� �
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