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<br />OHMRR'. HAMB (]7-b; 1-;Z~fA;. <br /> <br />JOB SITE ADDRBSS . <br /> <br />CITY OF ZBPgYRHILLS PERMIT APPLICATION <br /> <br />BUILDING DBPARTMBNT 533! 8~ BTRBRT ZBPRTRRILLB, FL 33&40 <br />Phone.813-780-0020 Fax.813-780-0021. <br />DATH ....CB.IVlID, <br />PLAHS RBVIBtf F.. . <br /> <br />PHONa CONTACT <br /> <br />LEGAL DBSCRIPTION, LOT(S) <br /> <br />BLOCK <br /> <br />PARCEL ID # <br /> <br />SUBDIVISION <br /> <br />WORK PROPSED: (JNEW CONSTRUCTION <br /> <br />(OBTAIN FROM PROPBRTY TAX NOTICB) <br /> <br />DSIGN <br /> <br />o ADDITIO~ <br />o MOVE <br /> <br />(JALTERATION <br /> <br />o REPAIR <br /> <br />o INSTALL <br /> <br />o DEMOLISH <br /> <br />PROPOSED USE: (JSGL FAMiLY DWELLING <br /> <br />o MULT I - FAMILY <br /> <br />0# OF UNITS <br />(JSWIMMING ~L <br /> <br />o MOBILE HOME <br />o OTHER <br /> <br />'I" <br /> <br />o COMMERCIAL <br /> <br />o INDUSTRIAL <br /> <br />PESCRIPTION OF WORK <br /> <br />CJ . RESTAURANT & HEALTH DBPARTMBNT APPROVAL <br /> <br />/1 ~ c;(-It~ ---~dr <br /> <br />. <br /> <br />BUILDING SIza <br /> <br />SQUARB FOOTAGE HEIGHT <br /> <br />RBSIDENTIAL: <br />COMMERCIAL. <br /> <br />~TTACH (2) PLOT PLANS & (2) .SETS OF BUILDING PLANS & (1) SBT ENERGY FORMS. <br />ATTACH (3) SETS OF BUILDING PLANS & (1) SBT BNERGY FORMS. <br />PROPBRTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. <br /> <br />PBRKITS RBQU.STBD <br /> <br />o BUILDING <br /> <br />$ <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />o ELECTRICAL <br /> <br />AMP SERVICE <br /> <br />o FLORIDA POWER <br /> <br />o W.R.B.C. <br /> <br />o PLUMBING <br /> <br />o MBCHANICAL <br /> <br />$ <br /> <br />VALUATION OF MECHANCIAL INSTALLATION <br /> <br />o GAS <br /> <br />(J ROOFING <br /> <br />(J SPECIALTY. <br /> <br />o OTHER <br /> <br />TYPB OF CONSTRUCTION: 0 BLQCK <br /> <br />o FRAME <br /> <br />o STBEL <br /> <br />o OTHER <br /> <br />FINISHBD FLOOR BLEVATIONS <br /> <br />IS PROJECT IN FLOOD ZONB ARBA(J YES 0 NO <br /> <br /> <br />BUILDS. <br /> <br />COMPANY <br />STATB CERT.OR RBGIST # <br />CITY PROCESSING # <br /> <br />SIGNATURII <br /> <br />**************************************** <br /> <br /> <br />~/~~~ ') /.1> COMPANy'7r'Oa.-.i-:._. Eer. <br />~----.- L4/ ,.. STATE CERT. OR REGIST # <br />"TORR ... . CITY PR~..;:~ * 9'1 <br />****************************************************************** <br /> <br /> <br />OTSS. . <br /> <br /> <br />SIGNATURE <br /> <br />COMPANY <br />STATB CBRT OR REGIST # <br />CITY PROCBSSING # <br /> <br />***************************************************************** <br />