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8'13,-780-0020 City of Zephyrl��IIS Pefflllt AppIlCa�1011 Fex-813=780-0021
<br /> ' Building Department
<br /> Date Recefved ,,,., �� "
<br /> -TT-f�T�TT-
<br /> � Phone Contact for Permitting `"r�"�`�r`�'"'��'��-a��`� � �r �'� '��•�'���
<br /> • � i
<br /> Owner's Name � � �y r � � �� � .
<br /> Owner Phone Number � �� ,�LI��', l ��
<br /> Owner's Address ��������� c�a ,r �,.� �T'� � '--�T-
<br /> . , �f��J� � .�Owner Phone Number
<br /> Fee 5fmple Titlaholder Name r �.y�. .� � • ,
<br />, Owner Phone Number
<br /> Fee Simple Titleholder Address
<br /> JOB ADDRESS (Q '� (',L C, " � (� ' � , ,� C.� LOT# �
<br /> .SUBDIVI510N ��� U•��� � ��
<br /> . � PARCELID# i �,�- � O, �
<br /> "'�: � �. �-- - r t,
<br /> (OBTAINED FROM PROPERTY TAX NOTICE)
<br />'' WORK PROPOSED ' e NEW CONSTR e ADD/ALT � SIGN
<br /> � 'INSTALL REPAIR 0 0 DEMOLISH
<br /> I PROPOSED U5E �r 5FR � COMM
<br /> I TYPE OF CO.NSTRUCTION ,�' 0 OTHER
<br /> � BLOCK � FRAME � STEEL � •
<br /> DESCRIPTION OF WORK O��t'� J�� 1 � ''
<br /> � c��'�n2Y L )�5;,1,�1+�,-�c z= � �J c�:�5 �:����)-�, ��.��{�,�-�
<br /> BUILDING SIZE SQ FOOTAGE �
<br /> ^'r'y"rr�-r-r-r-r�_�_�.r �=7� H E I G H T
<br /> r�-r�--�--�-�-�-rr-r-ru-�-r-v'-�-o�-r-rv-�'-r-�t-e-o-u-�-e-s�-Q-e--P-u-9--B-�P-n-o-II-o-�"o-u-u-r-
<br /> �BUI,LDING �
<br /> I I � . �� VALUATION OF TOTAL CONSTRUCTION
<br /> �ELECTRICAL $' AMP SERVICE
<br />, �� ��J'� 0 �nOGRESS ENERGY � W R.E.0
<br /> PLUMBING � �
<br /> [�� ' � �� � 9 3 7
<br /> MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION � �
<br /> . . G� ��� .
<br /> �GAS � ROOFING � SPECIALTY � OTHER •
<br /> FINISHED FLOOR ELEVATIONS `
<br /> , �J .Y / FLOOD ZONE AREA �YES NO � •
<br /> /
<br /> �-a-�-a-�--a-a-s--s-a_�-c-a-o--�---o-c-e-o-o-a-a-r�--a--�-s-y-�t-t-o--a-�;,-�-s--;--a-.�,-:-sea--s-��a-a-:-����-�o-,�-e-e-,�
<br /> BUI�DER
<br /> SIGNATURE � � '� COMPANY �. � _ �;-, �;�;��-�.,,,-� �"1,,.�
<br /> REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address 1��dv� %�l�-Gca .� ,� i" J�ia� �,. �
<br /> � License# ���.C����j� !v ;;� '
<br /> .�LECTRICIA�V ���^ �p ' ,
<br /> SIGNi4TURE "" �� COMPANY ��,�'l?,C)e�l,�,S�'",�'� ����t^-��^� �
<br /> , � • REGISTERED Y/ N F.EE CURRE� Y/N
<br /> AcJdress � 4���yJ����,p'�,0'"C� �.�`�
<br /> � � ;�� ��� ,
<br /> � Llcense# ���,�1�,�� �'��'
<br /> PLUMBER / /
<br /> 51GNATURE ����'`� __.. . . — COMPANY � ��..�,r��,(�,f. ..:���•G's�',�3���� ,�''�,��i,�'�;r�,��,�a �
<br /> � . REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address � � f�f'� mrl��r�-�Cr� ���d��,�
<br /> License# ���i� ���. �'�
<br /> MECHANICAL �� �
<br /> SIGNATL'IRE �"a'���=�..-.T�.�'�,....�.�m_�__.__ COMPANY �A`.�f�.r'�'(��,1�,J",���� ,�d�- ,�:, ,a7�eo,.7.J1" �
<br /> - �REOISTERED Y�`/ N FEE CURRE� Y/N
<br /> Address • ���� ,�-�-,,��F„
<br /> „/-� _ �C"x� f�c n.•.�.�''�,•��,�`�l`�-��j- �'
<br /> License# ������]��
<br /> OTHER • ,.r
<br /> 51GNATURE �,�- --�^�—^�, COMPANY ',,(�'` � Fn`�/�,�/ ). f .A ,,J J/�
<br /> � ,;''�- / I�('�1��• �'! Ir.y%'����i�' :���1�l`-���d'�
<br /> REGISTERED Y/ N FEE CURRE� Y/N
<br /> Address f����r -�"�,�f �l �� ,�/ l,,. � �
<br /> I��fln� �T�7' ��1�'
<br /> 1 1 A 1 1 1 `1 1 1 1 1 1 1 O 1 1 1 1 1 1 G 1 I 1 L 1 1 1 I 1 p 1 B 7 9 9 E 0 f Y L 1 1 1 1 1 1 7 B E .G G i 0 B 9 9 7 C B 9 B 8 0 1 B
<br /> License#
<br /> RESIDENTIAL Attach (2) Plot Plans; (2)sets of Building Plans; (1)s e t o f E n e r g y F o r m s; R-O-W Permi t for new construction,
<br /> M l n i m u m t e n (1 0)wor k fng days after submittal date. Required onsite, Construction Plans,5tormwater Plans w/Sflt Fence(nstailed,
<br /> Sanitary Facilities&1 dumpster;Site Worlc Permit fdr subdivlslons/large proJects
<br /> �OMMERCIAL Attach (2) complete sefs of Buflding Plans plus a L(fe 5afety Page, (1) set of Energy Forms. R-O-W Permit for new constructlon.
<br /> Minimum ten (10)�vorlcing days after su6mittal date. Required onslte, Constructlori Plans,Stormwater Plans w/Sllt Fence In
<br /> � .5anitary Facllit(es&1 durimpster Slte Wori<Perm(t for all new proJects.All commercial requirements must meet compliance
<br /> 31GN PERMIT Attach (2)sets of Engineered Pians. stalled,
<br /> �PROPERlY•SURVEY required for all NEW constructlon.
<br /> a-�6-a.._��-a-a-�-F-{--a._
<br /> )frectlons: 4'�-�--4-�-A-�_
<br /> FIII ouf appllcatlon completely. ���-�_��_�`����e"'���'��:Omu�-d�.�g_p�,�,��
<br /> Owner�,Contractor sfgn back of appllcatlon,notarized
<br /> IP over$25D0,a Notice of Commencement is required.
<br /> ' Agent(for tF1e contrector)or Power uf Attorney(for the owne(�ould be s m one w th�n)otarized letter from owner authorizi
<br /> NER THE COUNTER PERMITTINCa
<br /> er o o f s�i f s h i n g l e s gBN,��s �, ���P Y o f c o n t r a c t r e q u i r e d) n g s a m e �
<br /> ,ervice Upgrades A/C Fences (Plot/Survey/Footage) � � • ' � �
<br /> Driveways-Not over Counter If on�ublfc roadways,.rieeds ROW ' � , , .
<br /> • , ,- ,
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