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<br />CITY OF ZEPHYRHILLS PERMIT APPLICATION <br />BUILDING DEPARTMENT 5335 aD St, Zephyrhills, FL 33542 <br />813-780-0020 FAX: 813-780-0021 / / ,I <br />DATE RECEIVED 3 / ~ 6"7 <br /> <br />PHONE CONTACT FOR PERMITTING <br /> <br />OWNER'S NAME <br /> <br />G-eo 1'~ €- ~U-.. C' f' €l-t <br />(dt ;).1 ~ 0 f\-th.lu. \< ~ lJP-- <br /> <br />PHONE <br /> <br />8/3-?tS-?Yt:JS' !-I'),?1c <br />8/3-997-/770 c<(.(. <br /> <br />JOB ADDRESS <br /> <br />2. lp <br />33SY:2.. <br /> <br />LEGAL DESCRIPTION: LOT(S) <br /> <br />BLOCK <br /> <br />PARCEL In # 03-2' -2/-CJ/8o -00000 - oC:;8o <br /> <br />SUBDIVISION <br /> <br />WORK PROPSED: (JNEW CONSTRUCTION <br />OS IGN <br />PROPOSED USE: ~GL FAMILY DWELLING <br />o COMMERCIAL <br /> <br />(OBTAIN FROM PROPERTY TAX NOTICEl <br /> <br />o ADDITION <br />o MOVE <br /> <br />~ALTERATION <br /> <br />If( REPAIR <br /> <br />o INSTALL <br /> <br />o DEMOLISH <br /> <br />OMULTI-FAMILY <br />o INDUSTRIAL <br /> <br />0# OF UNITS <br />o SWIMMING POOL <br /> <br />o MOBILE HOME <br />o OTHER <br /> <br />DESCRIPTION OF WORK <br /> <br />R.ev\o..c~ <br /> <br />c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL <br />G-/ /1' J <br />:5" J tv feu!!' <br /> <br />~\d Ii.'. ~o.\I'Ck~~ c:\~1' (11 L~~ <br />SQUARE FOOTAGE <br /> <br />C ///I7;;({]' <br /> <br />BUILDING SIZE <br /> <br />HEIGHT <br /> <br />RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. <br />COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. <br />IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED. <br />PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. <br /> <br />PERMITS REQUESTED <br /> <br />o BUILDING <br />o ELECTRICAL <br /> <br />$ <br /> <br />1Lso~oo <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />AMP SERVICE <br /> <br />o FLORIDA POWER <br /> <br />o W.R.E.C. <br /> <br />o PLUMBING <br />o MECHANICAL <br /> <br />$ <br /> <br />VALUATION OF MECHANCIAL INSTALLATION <br /> <br />o GAS <br /> <br />o ROOFING <br /> <br />o SPECIALTY <br /> <br />o OTHER <br /> <br />TYPE OF CONSTRUCTION: 0 BLOCK <br /> <br />o FRAME <br /> <br />o STEEL <br /> <br />o OTHER <br /> <br />FINISHED FLOOR ELEVATIONS <br /> <br />IS PROJECT IN FLOOD ZONE AREAD YES 0 NO <br /> <br />c... ONTRACTOR;S. .ECTION <br />...., '"". -. .-.....". .".-._-., ',", " .. <br />' ,,', ,,', ........ , . ',', ,..".. ~ , '. ,"" , ",," -" "',, <br /> <br />BUILDER <br /> <br />SIGNATURE <br /> <br />~aJJWk <br />(/ <br /> <br />COMPANY <br /> <br />(p LV,A./l' 1'2- ) <br /> <br />STATE CERT OR REGIST # <br /> <br />****************************************************************** <br /> <br />ELECTRICIAN <br /> <br />COMPANY <br /> <br />SIGNATURE <br /> <br />STATE CERT OR REGIST # <br /> <br />****************************************************************** <br /> <br />PLUMBER <br /> <br />COMPANY <br /> <br />SIGNATURE <br /> <br />STATE CERT OR REGIST # <br /> <br />MECHANICAL <br /> <br />****************************************************************** <br /> <br />COMPANY <br /> <br />SIGNATURE <br /> <br />STATE CERT OR REGIST # <br /> <br />***************************************************************** <br /> <br />OTHER <br /> <br />COMPANY <br /> <br />SIGNATURE <br /> <br />STATE CERT OR REGIST # <br />