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a9$-�aaoozo City of Zephyrhill� Permit Applica�ion Fax 813-780-0021 <br /> -= • Building Degattntent <br /> Oate Recetv�d Phoae Con4act fo��eemt4f�n - t � — `'�� �`3 <br /> Ouungr's Fiarne 1,�� Y `VlV 1:..� t�wner Phort�Numbar <br /> Owner'��d�ress ��.uV� � C't VeSS S�• Own�r Phon�Number r� y.� <br /> �oo SImpY�Tl�l�hold�r Name �� � A�mer Pha�e Idumber � � <br /> Fee Stmple Titieholder Address <br /> JO�AD�it�aS �� � � � �Q LO'P� C�� <br /> SU�DINi3tOt� �,� ����(. ff��idCE6.t� <br /> . �-� —� a�-a� �� -��a�- - �3-� <br /> - (OBYAINED FROAA PROPEftTYTt�X IdOTICE) <br /> �o����o�os�� ��w cotasr� �DD1��T � s�Gr� �] � DE�►oLrsH <br /> w <br /> IiVSTALL FtEPAIR � <br /> P�o�o���.�s�� � s�R � co�t� � oT�eR <br /> 'fYPE O�COR9STRUCTIOR9 Q B40CK " Q FR�1ME �] STEEI. �] <br /> n�sc�i���ea��v�a�x �� 1 �,'�f��(1 �{�1�J� 1 <br /> �UtL�iFd{'s 512� �Qt FOO�°AGE�� HE1G�iT �_ <br /> ����L���� L � VALlfATION`C1F TO'tA�COiVSTRttCI'iORf <br /> �J <br /> Q ELECTRICA� �� AMP SERVICE Q PROGF2ESS ENERGY Q W.R.E.C. <br /> [,�PLUMBt�iG $ ��V�• �t\� <br /> V <br /> Q MECMANICAL $ YALUATIO�!OF MECFlANtCKI.iNSTA�..i.ATlQN <br /> A ���� p <br /> [�c�s C] �.00Fi�v� .�] s�ec},a�rE � OTtiER <br /> �INISHED FLOOR ELEVATIQNS ��� FLOOD ZOf�E AREA �YE5 NO <br /> �UI3.��6� G�A{QF��tY <br /> �t����'��� REGISTERED Y/ 111 FEE CURREP Y/N <br /> ,4d�r�s Liaense# i � <br /> �l,�CY�t�i&�t CO�YIF�AP(Y <br /> S�Ca�1�Y19$3� �' REGISTERED Y/ N FEE CURFtEP Y/iV <br /> Aelt�r�ss i.iaanse# � � <br /> I✓ ``-- <br /> ��.a����� ���n��r �-' . �� 1 �'1[�t� <br /> �tC�WATl7id� REGIS7ERm Y/. - FEE CURREN /M <br /> At�ds�r8 � l J��� $ �i.� �Y ' 1 L'iC@i1Se# t�J��-(J"t ���� <br /> P1���9i�9��sL CQ�dtPA}�Y <br /> ��G������ REGISTERED Y/ Pl FEE CUFtREP Y/M <br /> �t8t$Y�3 LiC8nS9# � � <br /> O��F�� C�fl���]Y .. <br /> S1C91�6i'8'�Ii3E REGIST�RED Y/ Pl._ �cuR�n Y/IV <br /> P.d�2r�s �Icense# ! � <br /> ���i����4�, Attach{2}Ptot P,tans,{2}sets of Sultding•Ptans;{1}set of Energy�Forms;R-0=W Perinit for new construction, <br /> Ahinimum ten(t0}working iiays_after,submittai da#e. Requlred onsite,Co�struction Ptans;S4ormwater'Fians w/Siit Fence instailed, <br /> Sanitary Facilldes&9 dumpster;Site Work Permit far subdivisionsAarge projects ' <br /> COR��1���8,�R. At#ach{3)comptete se#s af Ba3lding Pians plus a life Safety Page;{1}set of Energy Fornts.R-4 W Petmtt far nehv cxins#ru�on. <br /> PViinimum ten(1d}working days after submlttal date. Required onsite,Constructlan Plans,Stormwater Plans wd 3ilt Fence lnstailed, <br /> Sanitary Facllities�1 dumpster.Site Work Permit�or all new projects.AJI commercial requlrements must meet comptlance <br /> SICa�4 P�Pd�{J&'P ,4ttach{2}sets of Er�ginee[ed-Platts. <br /> •••`PROPERIY SURVEY requUed for all NEW canstructian.. <br /> DlPeetlan�: - <br /> F(tl out applicatlon completsiy. <br /> Owner 8�Contractor sign back of appi[ca�on,notarized '� <br /> tff a�e�e$2�00,a Plaaiice of G��m�nceera�n�3���q�si�ed. {�JC tap��d�av�e��5�0} <br /> '" Agent(for the contractor)or Powrer of Attamey(for the owner)woutd be someane with notariaed letter from owner autharizing same <br /> tDll��3 T���oili�l�E���l��IrntdG (Front of APa�tcatton ontY) <br /> Reroofs if shingles Seuvers Service Upgrades A/C Fences(PIoUSunreylFootage) <br /> �rtvexvmmy�-�Iot aver Gaunter sf on pu6lic raadways..nseds F30W ,, <br /> i <br /> � _ <br />