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<br />I OWNER'S l1AME <br /> <br />CITY OF ZEP!iYRHII.lIJ8 PERMIT APPLICA'rION <br />BUILI>IN(~ DEPAR'l'MlllN'r 5335 8th 8TRlllE'r ZBPHYRHILLS, FIJ 33940 <br />Phon61813-780-0020 FaxI813-780-0021 <br />DATB RBCBIVIID _~.;2,;2- t2:Z __. <br />JilI,ANS RBVIBW "B. <br /> <br />C-I'L;o-......J <br /> <br />PHONE! CONTACT <br /> <br />JOB SI'I'E ADDRESS _?<./ I 'l- 'i <br /> <br />PARCEL to # <br /> <br />LEGAL DESCRIPTION, LOT(S) <br /> <br />BLOCK <br /> <br />CN<."........J 1+01"1:::'" <br /> <br />SUBDIVISION <br /> <br />(OBTAIN (I'ROM PROPERTY TAX NOTICE) <br /> <br />WORK PROP8ED I 0 NEW CONS'I'RUCTION <br /> <br />D ADDITION <br /> <br />llAUfERATION <br /> <br />[] REPAIR <br /> <br />IJ INS1'AIJI, <br /> <br />DSIGN <br /> <br />rJ DEMOLI SH <br /> <br />[J MOVE <br /> <br />PROPOSED USE I OSGIJ FAMILY DWELLING <br /> <br />DMlJLTI - F'AMtLY <br /> <br />0# OF UNI'I'S <br /> <br />EtM6BILE HOME <br />o OTHER <br /> <br />o COMMERCIAl, <br /> <br />o SWIMMING POOl, <br /> <br />o lNDUSTRIAI, <br /> <br />o RESTAURANT & HEALTH DEPAR'I'MEN'1' APPROVAl, <br /> <br />/hi( Sd~ <br /> <br />BUILDING SIZE <br /> <br />DESCRIPTION OF WORK <br /> <br />RESIDENTIAIJ I <br />COMr-1ERCIAIJ I <br /> <br />D BlJII.I)UIG <br />[J HlIJEC'l'RICAL <br />[] PI,UMBHW <br />0 MmCHANICAL <br /> <br />[] (JAS <br /> <br />o ROOF lNG <br /> <br />SQUARE FOOTAGE <br /> <br />HEIGHT <br /> <br />A'l'TACH (2) PLOT PLANS & (2) SE'fS OF BUUJDING PLANS & (1.) SET ENERGY FORMS. <br />ATTACH (3) SETS OF Bun,DING PLANS & (1.) SET ENERGY FORMS. <br />PROPERTY SURVEY REQUIRED FOR AL,I, NEW CONSTRUCTION. <br /> <br />PERMITS REQUESTED <br /> <br />$ <br /> <br />VAl.tJATION OF TO'1'Al, c!cmS'I'RUCTION <br /> <br />AMP SERVICE <br /> <br />o W.R.E,C, <br /> <br />o FI,ORIDA POWER <br /> <br />$ <br /> <br />VAI,UATION OF MECHANCIAIJ IH8TAIII,~TION <br /> <br />[1 SPECIAUrv <br /> <br />[J OTHER <br /> <br />'l'YPBl OF CONB'l'RUCTION I L1 BLOCK <br /> <br />o FRAME <br /> <br />o STEEI~ <br /> <br />o OTHER <br /> <br />FlNI811ED FLOOR ELEVATIONS <br /> <br />IS PROJECT IN FLOOD ZONE AREAO YBlS CJ NO <br /> <br /> <br />BUILDBR COMPANY ~- <br />~~1f} STA'I'EJ CEJRT OR REGIST # ___________. <br />8lGNA'fURE w~~ CITY PROCBl88IN(~ ~ <br /> <br />****************************************************************** <br /> <br />IILJllCTRIUIAN <br />SlGNA'l'IJRE U-1'~!J~~.- <br /> <br />PLUMBER <br /> <br />SIGNATURE <br /> <br />MECHANICAL <br /> <br />SIGNATURE <br /> <br />OTHER <br /> <br />COMPANY ,.,c.. '"'- <br />STATE CER'I' OR REGIS'!' # <br />CITY PROCESSING # <br /> <br />****************************************************************** <br /> <br />Lf~ <br />COfvIPANY- ... __ <br />STATE e'ERT OR REG 1ST # <br />CI1ty PROCESSING # <br /> <br />0-J' ~-ey;K2 - <br /> <br />****************************************************************** <br />COMPANY n~ "-./ <br />. <br />STATE CBlRT OR RBl(HBT # <br />0C;r dJ~ CI'I'Y PROCBl8SING # <br /> <br />***************************************************************** <br /> <br />COMPANY <br />STATE CERT OR REGIST # <br />CITY PROCESSING # <br /> <br />SIGNATURE <br /> <br />***************************************************************** <br />