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�` s��-�sn-oozo City of Zephyrhilis Permit Application Fax$13-780-0024
<br /> • Building Department �.
<br /> Date Received �Z,�,�� zD / �j ,f� '"'
<br /> • �Phone Cbntact�for Perm[ttfng , G�� Z`c-�' — ���S��
<br /> Owner'sName �/V G'�i (� l�sc�.+''e! � OwnerPhoneWumber �Z'��z�� "`L�3�S�
<br /> Owiner's Address ���� /G C=�G,/�/ ���,'/� Owner Phane Number___� .
<br />� Fee Sim�S1e Titlehoider Name Ovi►ner Piione Number � , �
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<br /> Fee Simple 7itlehotder Addcess
<br /> JOB ADDRESS �T f� �Q�' 2C��'- 1 L01'# ��.�
<br /> St1BD1U1SiON � � PARCEI�ID#. .
<br /> (OBTAINED FROM PROPERTY TAX PIOTICE)
<br /> WORK PRClP03ED ,. NEW CONSTR`• ADDJAL'T �� SIGN Q � Q DEMQ�ISH
<br /> � INSTALL 8 `REPAIR '
<br /> PROPOSED'USE Q SFR Q '°GON{M � QTHER ` LUt�v �'�vCc
<br /> TYPE°OF CONSTRUCTION Q BLOCK • Q FRAME [,� STEEL Q
<br /> ' 4� .
<br /> �ESCRIPTiON OF WORK R ��.����t ��-f��� -��X� ,� �� �
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<br /> B[Jtl�lali�lG SIZE �� � 8Q FOOTAGE��� HEtGFiT-�C` �
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<br /> �BUtLDlNG � ��Q ��� VAI.UATION`•OF TG?TAL CONSTRtlCT.ION
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<br /> �El:ECTRiCAL �� Ai1r1P SERVICE Q PftOGRESS ENEFtGY Q W.R.E,C.
<br /> QPLUM8ING �... � • ���/
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<br /> QMECHANICAL $ VALUATION!?F MECHANlGAL INSTALlAT10lV
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<br /> [�GAS Q RQQFING C]_ SPECIALTY � OTHER
<br /> FINISMED FLOOR EI.EVATIONS � FLOOD ZONE AREA QYES NO
<br /> BUtCDER � -� COMPAt�IY
<br /> SIGPIATURE REGISTERED Y/ N FEE CIJRRE� Y/N
<br /> Address o �PF�1Z. E'�'�u�r�t'6l .��e= Etl�,.'- 3�S'�5� �Zicense.# � �
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<br /> `�;'El�EC,Tit[G(11N , COMPANY ,
<br /> I ;,.SIGNATURE REGISTERED Y/ N ` FEE'cuR�� Y/N_
<br /> � Address ` - License# �
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<br /> �� P.Lt1MBElt.,; CQlIAPANY�
<br /> �" •SIGNATURE` �"' t��isTeREo Y•/ N • FeE Gut�n Y/N
<br /> Address - Lioense# � �
<br /> �;,MECfiANICAI:. - . � COtV6PANY
<br /> ;;'�SIGNATURE" � " ` � ` � �REGISTEREp , Y/ N FEE CURRE� . Y/N
<br /> � AdBress�r' _ License.#.�� � �
<br /> : xti"s:•s . .. .... .. .. _ , �
<br /> '":~.OTHER:.: � - -� ' , . GONIPANY '
<br /> r�.,; _
<br /> '.;=SIGNATUREc:;i�:'r: - ' � ' REGISTERED ' Y/.N FEE-CURREK , Y/N
<br /> • ;.i?:'i?�,.:4�fi.v> "� � . ' . .. :....: . . . . . , . , . .. . � �
<br /> Aitdress:,.. .,��; r}. .��; - , , .� •�; ' L:ioense#
<br /> {:�..`.'�`.�� ." . . .. u_.. �... _ '4krx f A::�a:..r ,.,h. . '�.:. �... ..,, .f ' ' - ' �
<br /> ;��RESIDEN'TIJ4L,:�:;:Attach;�,�2)'�Plot Plans;:{2):se#s`of�Biiildfng�.Plan"s;(1)�set''of�Energy`Foim"s;,R=0�11V Perrsiit for-`new.constiuction,,
<br /> .� . .,-.. , . , �-;. , ,,_�:
<br /> '','� , T-.�::.,'�=:a�:�;�Minimum�tenz(1:0);viro,�king'�'day��aftersu6�iittaUdate.`�Required`onsite;`Constr`uc#3on'Plan's;Stor`mwaterPl.arisw%SiltFence.installed;
<br /> � � ,.".`y,� - Sanit�ry,Facal(bes&1 dumpster,�Sit�Wor.k;P.ermlt-for,st�bdivis'ions!large,';proJeots°�..-, " �•:`.• : "
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<br /> � GONfMERC1AL Attach�(2)-cample#�'sefs't�f Bu[laing Plaris plus a Cife Safetyr Page;{1}set of Energy Forms.R-O W Permit for new construction.
<br /> "'��"' .. Minimum ten(10)working days after submittal date. Required onsite,Canstructian Plans,Stormwater Plans w/Silt Fence.installed,
<br /> �,:.%,': .
<br /> �..-.: Sanitary Facilities&4 dumpster.Site Work Permit fot�ali�new�piojecis.Aif commerciai requirements mast meetcompllance
<br /> ��.�StGN;.pElt�iliT `Attach'°(�)sefs;of-Erigineei;eii�Plans;>f� • . - � `
<br /> ��x`�_' ""'"PRORERTYSURVEYreguired,for,.aII,NEWcanstructlan._ . .
<br /> �= - -
<br /> r.;Diiecticins: �;�;��,�;a. �,;-
<br /> ```�F(Il.out applicatlon completely.
<br /> j'`= O.virner'&=Contractor.sfgn.backofappticat�on,natarized
<br /> M..,:
<br /> �: If pver;$ZS06;.a Notice.of Commencemant ls required. (A!C upgrades over$750Q)
<br /> ;`;.. .,..:�,..,..•;�,•,,.: ._, - .
<br /> ��"` ,Agent(for'th'e�conttactor)>a��Fower•of�Attomep{for ttie owner)would'be someone with notadzed letter from owner authodzing same
<br /> �`:t3VER;THE COUNTERpPERMiTTiN,G,.,,:,. .,(copy,.of contract:requiredj " "�` �' ' � �
<br /> �"aReioofs if:sliingies � Sewers Service Upgrades A/C Fences(Plot/Survey/Footage) +
<br /> } Dirtveways-Not over�Counter if on public'r'oadway's".'`needs'ROW
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