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813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 <br /> Building Department <br /> Date Received d 5 <br /> ve -Z ].Phone Contact for Permitting <br /> .-r-Y-771 I III I I I I <br /> Owner's Name Judy Shirk owner Phone Number 1-813-715-2634 <br /> owners Address 137350 Derbyshire Dr Owner Phone Number <br /> Fee Simple Titleholder Name I Owner Phone Number <br /> Fee Simple Titleholder Address I <br /> JOB ADDRESS 1 37350 Derbyshire Dr Zephyrhills 33542 LOT# 100 <br /> SUBDIVISION Wedgewood Manor PARCEL to#1 10-26-21-0120-00000-1000 <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED NEW CONSTRR ADD/ALT SIGN DEMOLISH <br /> R INSTALL REPAIR <br /> PROPOSED USE = SFR = COMM OTHER <br /> TYPE OF CONSTRUCTION 0 BLOCK Q FRAME STEEL <br /> DESCRIPTION OF WORK Replace size for size 11 Windows, I Door <br /> BUILDING SIZE I I SQ FOOTAGE= HEIGHT <br /> "V . . . . . . . . . . . . . <br /> UILDING $8878 VALUATION OF TOTAL CONSTRUCTION <br /> =ELECTRICAL 1$ AMP SERVICE 0 PROGRESS ENERGY W.R.E.C. <br /> =PLUMBING 1$ <br /> =MECHANICAL 1$ VALUATION OF MECHANICAL INSTALLATION <br /> =GAS = ROOFING = SPECIALTY = OTHER Oki/ <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YE S NO <br /> 41 — COMPANY Window and Door <br /> SIGNATURE _/ 01 REGISTERED I Y/ N FEE CURREN LY_LN J <br /> BUILDER 2, Lipton <br /> f4=4 <br /> Address 117335 Gunlock Rd Lutz FL 33558 License# I CBC1258461 <br /> ELECTRICIAN COMPANY = I <br /> SIGNATURE REGISTERED I Y/ N FEE CURREN <br /> Address License# <br /> PLUMBER COMPANY = <br /> SIGNATURE REGISTERED I Y/ N FEE CURREN <br /> Address I License# F_ <br /> MECHANICAL COMPANY = <br /> SIGNATURE REGISTERED I Y/ N FEE CURREN <br /> Address License# <br /> OTHER COMPANY = <br /> SIGNATURE REGISTERED Y/ N FEE CURREN <br /> Address License# <br /> IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIItlillllllltlllllllllllllll <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction <br /> Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities&1 dumpster,Site Work Permit for subdivisions/large projects <br /> COMMERCIAL Attach(2)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction. <br /> Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans wl Silt Fence installed, <br /> Sanitary Facilities&1 dumpster.Site Work Penrill for all new projects.All commercial requirements must meet compliance <br /> SIGN PERMIT Attach(2)sets of Engineered Plans. <br /> —PROPERTY SURVEY required for all NEW construction. <br /> 9 9 1 9 9 11-41— . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Directions: <br /> Fill out application completely, <br /> Owner&Contractor sign back of application,notarized <br /> if over$2500,a Notice of Commencement is required. (A/C upgrades over$7500) <br /> Agent(for the contractor)or Power ofAttomey(for the owner)would be someone with notarized letter from owner authorizing same <br /> OVER THE COUNTER PERMITTING (copy of contract required) <br /> Reroofs if shingles Sewers Service Upgrades AID Fences(Plot/Survey/Footage) <br /> Driveways-Not over Counter if on public roadways..needs ROW <br />