|
$13ae0;0020 City of ZephyrhillS.PermiYApplication Fax
<br /> Building.Department '\
<br /> agrOn @ S�ltrrles pe•m I
<br /> Da�e-Recelired: Z ...:
<br /> 7 20 ZC7 Phone.Co;#aL t,,f6r,Penrrittin $l7J a
<br /> .n
<br /> ..{... . �.Own e '..:. ; -%` mti�.Orl ®
<br /> /
<br /> b wn Y 2. S:. b
<br /> e a�.d rit,d esg: .:2 :a-� D A nb:Nu
<br /> duu'i�ar;PhOn®,Nutt®r:'
<br /> ..:76�r`
<br /> -
<br /> ' :JOB Adl)ftE$S::. . �o i
<br /> VISION. "Oct
<br /> (QBTAINED N614. OPERTIF�Axdwftxldls
<br /> .Y
<br /> iy�S.WO�,K;PROPOSED.y. . .. - _AF ..CONSTa:• RD/ L , .
<br /> ,
<br /> 1.•
<br /> PROPOSED.USE -.010 OTHER
<br /> ..1...:.:...
<br /> ME: '�E TYPE`•OF.CbNS 'I� BLOCK RA •�-.�-�
<br /> a�I 0.l44
<br /> 14r1s SY►ow `Cme ¢1f1i aTt YCV15 or o► v r
<br /> DESCf?IpTION O .WbitK'.:.. , et�ING:SItE OTAGE;BU1LD O
<br /> ,'fie.. ..�:;• ..r,.:.?; „V.. `rf,. .-+. i•1T�'-.
<br /> -
<br /> • �• BUILDING ;$ . . . .. .,: , . ..'. :
<br /> :.: , . :. -
<br /> VALUATION:Ol=�7 OTAL.CONSTRUCTIt7N r:
<br /> EOco
<br /> LECTRICAL.. $, AMP',SERVICE DUKE:EIVERGY=; ��]r. ':;-VUR;E:C._.
<br /> ..:;
<br /> QMECHANICAL $ VALUATION.OF.,MECHANICi4L'.INSTAGt11T110N1 I(a
<br /> GAS ROOFING.. .' (/- ,SPECIALTY:: OTkIER::._..
<br /> ;FINISHEDfFLOOR-.ELEVATIONS :•• Lt OQZONE'AREA%`:.'',, - YES"'" ..`NO:
<br /> COMPANY:
<br /> BUILDER .::•~. `t;
<br /> SIGNATURE
<br /> ,,:..--,: ..� 330:. Mears �jwq�•� .: ..:..�.,: ',.,- <.._:<. -. ...... ..-'
<br /> .r- FL 3
<br /> 77
<br /> ELECTRICIAN' ,.COMP. I l a�d's
<br /> SI�NATIjE %(tEGf$1f� D: Y`/;;MS'! 3 EEEtiCI$RRE�;,
<br /> -
<br /> Address :1026� s a Je Tarn $3
<br /> :COEYI-irYN Y::::+, { -3
<br /> - - ~
<br /> :SIGNATURE
<br /> REGI$�ETtE'6' ;Y% N. s;"?°'FEEiCURR(ao::'
<br /> Address ,> Lieeiise:#=;!
<br /> MEOHANi.AI
<br /> 'COMPl1NY?
<br /> SIGNATURE?:::
<br /> RL �Srtl3EQ.a Y J.N FEE CURREP" ":; t^•,•:;a
<br /> �Addr®ss.�
<br /> '.COMPANY; :°: •.:_
<br /> OTHISk _.,..
<br /> tiGNAluk
<br /> 1$1ERED`= xY%a'Mcv
<br /> . Addras . ..._ .... . >... _...... .. . -,... ;::.,:. ..••::;, F.ti; _ :Uce�ns
<br /> ,^:41,.�': j �.S(:' '.`Y. :tie' +/><' - -:y`, _ :'Y-'_•
<br /> i. G-
<br /> - -
<br /> 4
<br /> •'9
<br /> P. qq� pp
<br /> ,f r:
<br /> x i'•
<br /> .w• WOyy».• -
<br /> I '�
<br /> '�ae'
<br /> n orals.R- �t• vie [•
<br /> "rfi tr f al;' 1> e h f� �t ���� "°'tab� ., �s
<br /> j� `•Atta�Frx-���ot�lc 's�.c ��e. { 0. (..at_. ) Y •,•�.... >!�!�...
<br /> RESIDENTtA1.' f�' .� ^+7 M! J� 'd.A7 ri+ .u,d�• � `)1:,• "C:.I.
<br /> 9 0>- Y F n
<br /> 'Workitig�daeseff��stiille�l•. ate:'°6taire��o s fh•Con t��ctldr�•P..Ian'rrs'��o�i1✓ateFP,,ldtis���il('l€gc®:ft,stallsd'r""
<br /> . Santtacy%FBCilitles':•8�•�umpstar�Sifa,Vllot�c}Peiritit�Or'.�subdivi'�t'oa�li�t�s��prolbcts' •�` i ' `: - = - .
<br /> COMMERCIAL :Att80h..(2)oonipiete sets:of Buifdtrg Ptansipfus PagB,{1)"$et°of Energy°Foiim ;•'R=O=W:Permit;for;nevirCax+
<br /> 'Mlhimilm't8tl'`70)�nrGrliln fJa: %after a"bfi�i(tfal� e c j eaq fed'grisite;Consfn�,ct oi> �§i�sr,Stormu atet�61ns w/. jo Onf Ohio We
<br /> '•-
<br /> �xo a
<br /> Sanitary'FaC I(ii®s&1 tlu�ietr;SiieTTllork I��rmitor aII new:�p(6Jeels':Altcommerdal: quirements must riieet;Complf&nce'
<br /> SIGN'PERMIT Ailacli:(2.)setsfof ng„ 6d''lens,:.
<br /> "'•`PRbP R t s '.RVEr°Yequired fot'aIP;N�W:coiistruction:. ±-�
<br /> .. .$ .. .eta: :.:. ,
<br /> Directions:
<br /> .Fill out application completely.
<br /> Owne'r''�'Con•,; ctorsign ,ack,ofNapR�,lcatton;notarized._ {
<br /> .. ''If dvaC325d6;a'.Noticd''of Commengertrsnt.is requtred: :(AIC upgrades over$7500)
<br /> + �s ;.:•,:,: wnet:authbttiiegaame
<br /> Agent:(for:`tlle coot'actor)or..Power<ofAttomey;(fbr:theoWner):wbuid b:esom8bne with not6Hie8;l8ttei'fiom b
<br /> OVER,T"g.:C,00NTERiP.ERMITTING . ..,:_(copy rof;Oor bOr ;requirgd),.
<br /> ReroSfs if,shtrigles Sewers Service iJpdiad"&;.-Ai ' Teri ejlilot/Survey/Footage)
<br /> Driveways-Not over Counter if on-public roadways..needs ROW
<br />
|