|
- e�saso-oozo City of Zephyrhi(Is Permit Application Fax-813-78Q-0021
<br /> , Building Departinent
<br /> Date Rece3ved . ' �t::�`�.�.�P�r'd�a,f�'r�,,c'°' �"�a^`""�� °'�°�`�.�s�~'D
<br /> • Phone Contaci for Permitting
<br /> -!-]"'C�T-1-['r l�- (�
<br /> Owner's Name �, � C.�,r � t-. . k= Owner Phone Number ���i. Z �� f!
<br /> . �• �.-�2.
<br /> Owner's Address (��'p��'�'��= '�-"�` `�'"' �`r TG'"�"f°��'J � �Owner Phane Number �
<br /> �, Fee Simple Titlehotder Name � ����� '� �� Owner Phone iVumber � �
<br /> �� _Fee Sirr;ple Ti#lehotder Address
<br /> J08 ADQRESS -� � f��-C'C t�, e�� t„)� �'� L.OT# (�
<br /> SUBRIVtSIQN J�f � l:a��.("G c�c'a � PAf�iCEL iD# `"rf�`c^t l,!-^' . � -� .-•���
<br /> {qBTA1NEQ FftOM FROPERTY 7AX NOTfCE)
<br /> I WOAK PAOPOSED NEW CONSTR ADD/A�T � S{GN � 0 DEMO�iSM
<br /> �, �'INSTRLL 8 REPAIR -
<br /> � PROPOSED U5E . �� SFR � COMM �] OTHER
<br /> TYP�OF CONSTRUCTION �� BLOCK � FRAME � STEEL �
<br /> �� �•4 (�• •�t.,,,_� � L �/ � .' ,.K � ��.:�+-► ---�C+�-
<br /> CtESCRIPTtON OF WORK � 'x1 � � �^ �j��,"'�� G'� 4
<br /> BUILDING S}2E � � �Q FCiOTAGE ��� ���. l�tE1GHT �___�
<br /> ..t'�e-r-t-�-r�v"rt-►-r-rrrrrr-r-r-t-t-rrr-r--r�t"r't-r-rr�rr�'-r'-�r-v"rrrrsr"r'�-rY-1r'a-t`-P'�-e-r"�-rma-�rr'^a�s-e-e"v�e--r-
<br /> �,BGILDING $ j r'v'�l��t�� VAWATION QF TOTAL CONSTRUGTlON
<br /> � 11'-
<br /> �ELECTfl1CAL $ _ ,��� AMP SERVlGE �� PRQGRESS ENERGY 0 W.R.E.0
<br /> U
<br /> [�PLUMBING $ n ,'��
<br /> , , -.��� �l./J
<br /> �� �
<br /> �MECHAN{CAL $ y VALUATIQN OF MECHANICAL INS7ALLATION ��
<br /> (,}C,�''�,�.i
<br /> ��AS �� ROOFING � SPECIALTY � OTHER
<br /> FIN(SNED FLOOR ELEVATIONS � ��! t,� FL4C?D ZONE AREA �YES NO
<br /> l t.J._._..j
<br /> -�S�-C-�-i�-1-�G'-h-A�-d-'0-4--6�-C--Z-'�'�''-F--G-i4--k�-�--4-F�r-�6-'G-�--ir-F-G-'r+'r'r-'�-R�'-`�Gi-$-F'u-'v-c-8-�'�6-�'v�'rr�-6�-6-a-��F�$��-C-'�-€-P-�-
<br /> BUILDER � ���� �,/��. COMPANY �1./� � _ �%--1 e�:-''�-c°��'-�, ��'t-�
<br /> SIGNATURE �"���- ftEG1STEREO Y/ N FEE GURRE� Y/N
<br /> /�ddress fc��'c7v� l���"<'Ck.� ,� �""" I��a� �=-• Lieense# �-"��.C�,��C� � :��.
<br /> .�LEGTFtlClA�! �lN��,,�;•r,,,.-,i"�,.�-r � Ct3MPANY ��°f`l'�,�.7a�,.��,�1' �,.��,=�'�.N�'A �
<br /> SiGNATtIRE �( REGIS7EFIED Y/ N F.EE GURRE� Y(N
<br /> Address 6��..����=�'P�,�'*�'`� �,� � r?'�- �� License# /,.����5��'<..,� ,��G�
<br /> d
<br /> j� �+ ,�/ ������ �`
<br /> PL.UMBER �� COMPANY ' f`" /J'��`,Finf.�,�` .:���.����,�'�:�!� �1?fF'�+ �
<br /> StGNATt1RE ����T� REGISTERED Y( N FEE CURRER Y j N
<br /> Address X''������''f���� T t�u�/7�`r�°°; ����c r�� License# ��`m� ���,t' /��`�
<br /> P
<br /> MECHANICAL ��e��� ..,�„ ����,,..�..-----_._COMpANY i' �.i�,.i}��`.�,Snkj,{�'�%' �rd`' �,. ,;i-v�a�'?.,�
<br /> SlGNA7l1FtE t,.-�'� �'" �� REGISTERED Y�( N FEE CUFIRE� Y(RI
<br /> Address ���1� ,/.��-1^,"��F- �� fv��..a�F"�.•vr,�,1`���� License# �����:�,�fi�k� ��
<br /> ' .J �~ l.'l��'�' 0!' �' �� �
<br /> OTHER - ._-�--.----•- COMPANY tr,"'� �F",, �•�?�C'c:.�' �/,�,��;.,7r�„�'"1��''
<br /> �`�, '}�;F°
<br /> SIGNATURE � � � REGISTERED Y J N FEE CURRE� Y/N /"
<br /> Address �j!��c,►��_�'� /�j�n;- ,,�'����� License# � �
<br /> i t i i i I 1 I 1 ( I 1 A / I 1 1 I 1 ! ! ! ! ! 1 I ! 1 t i t 1 1 1 M 1 1 6 1 1 E B 1 I 1 1 I 1 6 1 1 B I � 1 9 6 II fl B 6 8 ! 9 6 6 1
<br /> RESlRENTlAL Attach(21 Piat P(ans;(2}sets of Building Plans; (7)set of Energy Forms;R-O-W Permit for new construction,
<br /> Minimum ien{10)working days after submittal date. Required onsite,Construction Pians,Stormwater Plans w!Siit Fence installed,
<br /> Sanitary Facilities&1 dumpster;Site Work�Permit for subdivisionsllarge prajects
<br /> COiNMERCtAL Attach (2.}comp�ete sefs of Building Plans plus a Life SafeYy Page; {1}set of Energy Forms.R-0=W Permit for new constructlon.
<br /> Minimurr�ten(10)working days after submittal date. Required onsite,Constructlon Plans,Stormwater Plans w(Silt Fence installed,
<br /> ' Sanitary;�acitities&� dumpster.Site Work Permit far al!new prajeets.R!l commerciaf requirements must meet compiiance
<br /> SIGN PERMIT Attach(2;sets of Engineered Plans.
<br /> ` ****PRO;=ERTY•SURVEY required for al(NEW construction.
<br /> .:6-i-E-�d-�b.-i.-3.-d-6-.d-.�-1.-B-.i-6-.4:�.-0-G-b-.i-.B-A.-0-.8-.6-l.-9.-d-E-.2-3-6.-E--9-8-8-d--8.-&-@-..�.�8-.�-E-�-b�•8.-8--8�.E-�.&-��-�G�B��.A--&-@�B�.�-�.�-8�4..
<br /> Directions:
<br /> Fill out application completely. -
<br /> Qwner�Contractor sign back of application,notarized
<br /> if over$250D,a Noitce of Commencement is required. (AIC upgrades over$fi5o�) � ' ' ' �• �- - ,
<br /> ** Agent(for the contractorj or Power of Rttorney(for the owner)would b'e someone with notarized letter froin owner authoiizing same
<br /> OVER THE COUNTER PERMlTTING {copy of contract reqvired}
<br /> Reroofs if shingles Sewers Senrice Upgrades A(C Fe�ces(Plot(Survey/Footage) 6_ ,._,._,_r , -
<br /> Driveways-Not over Counter if on;�ubiic raadways..needs ROW , �•- �- " ; `+,y ,y:. ,
<br /> � , :r�.,
<br />
|