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813-780-0020 City of Zephyrhills Permit Application Fax 813-78"021 <br /> Building Department <br /> Date Received Phone Contact for Permitting <br /> *as-as* <br /> cnf�-) Owner Phone C—A 1-1-4 171 S—(09 <br /> Owner's Name no Number S— <br /> Owner's Address Owner Phone Number F- <br /> Fee Simple Titleholder Name Owner Phone Number <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS ,j(7,fne, 7 LOT# <br /> SUBDIVISION PARCEL ID# U2-ZZ -00000 - 0 <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED NEW CONSTRR ADD/ALT SIGN = DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE = SFR Q COMM OTHER <br /> TYPE OF CONSTRUCTION BLOCK FRAME STEEL <br /> DESCRIPTION OF WORK f; ' 15 -�P-c\V Nr�,,p C'xcirnz- joul- <br /> BUILDING SIZE SQ FOOTAGE HEIGHT <br /> Arww ELIL AL IL JL AL J& ill <br /> =BUILDING VALUATION OF TOTAL CONSTRUCTION <br /> =ELECTRICAL AMP SERVICE 0 PROGRESS ENERGY Q W.R.E.C. <br /> =PLUMBING 1$ <br /> =MECHANICAL 1$ VALUATION OF MECHANICAL INSTALLATION <br /> =GAS = ROOFING 0 SPECIALTY OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA ='YES NO <br /> BUILDER COMPANY I <br /> SIGNATURE REGISTERED Y/N FEE CURREN L_Y2 N_j <br /> Address License# <br /> ELECTRICIAN COMPANY <br /> SIGNATURE REGISTERED Y/N FEE CURREN <br /> Address I License# <br /> PLUMBER COMPANY <br /> SIGNATURE REGISTERED Y/N FEE CURREN Y J�N <br /> Address License# I <br /> MECHANCAL COMPANY [� i W <br /> SIGNATURIF---LL_L REGISTERED Y/N FEE CURREN Y/N <br /> Address 1-1(ODS L—C\ke5 JR)0 J. [,{it ril License# (P <br /> OTHER Y COMPAN = <br /> SIGNATURE REGISTERED I Y/N L_jLN I FEE CURREN _j <br /> Address License# I <br /> :94.1111149 24 911-A.- 94 9 2 1 S.W.14 W a a ax,as SA S-1 a 214*I a W:XX.ff a S:t 1114�1111!1.1 <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.Rpm drPrI e%nQi+. r—+�—6—Dt--- <br />