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<br />CITY OF ZEPHYRHILLS PERMIT APPLICATION <br />BUILDING DEPARTMENT 5335 8TH st, Zephyrhills, FL 33542 <br />813-780-0020 FAX: 813-780-0021 <br /> <br />DATE RECE lVED <br /> <br />/0 .- cP!f -oi <br /> <br />PHONE CONTACT FOR PERMITTING gJ3 Z'?Cf j III <br /> <br />JOB ADDRESS <br /> <br />f (~f (l.. /7,0 o~rl-1i3 <br />. J <br />38' /lJS 13 ~ Av€..-Jt.""z <br /> <br />L/ {.,. G PHONE 1 z, 'J ',-,} $1- tJ <;30 <br />Ze:f~1r'ht tls I fL '3 'JS,TI <br /> <br />OWNER'S NAME <br /> <br />LEGAL DESCRIPTION: LOT(S) <br /> <br />BLOCK <br /> <br />SUBDIVISION <br /> <br />(OBTAIN FROM PROPERTY TAX NOTICE\ <br /> <br />PARCEL 10 # <br /> <br />o SIGN <br /> <br />o ADDITION <br />o MOVE <br /> <br />o ALTERATION <br /> <br />o REPAIR <br /> <br />o INSTALL <br /> <br />WORK PROPSED: ONEW CONSTRUCTION <br /> <br />o DEMOLISH <br /> <br />PROPOSED USE: OSGL FAMILY DWELLING <br />o COMMERCIAL <br /> <br />OMULTI-FAMILY <br />o INDUSTRIAL <br /> <br />0# OF UNITS <br />o SWIMMING POOL <br /> <br />o MOBILE HOME <br />o OTHER <br /> <br />BUILDING SIZE <br /> <br />RES I DENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET E~RQif"FORMS. <br />COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS'~~l?o~O <br />IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED. (" <br />PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. <:;>~'{""" <br />1h0l'iLL-r <;1 ~ M~I r{/!} ,1'1 . ()l9Sr-l ~ fl.>Jr< en=- '. l-VQ ;"~ <br /> <br />PERMITS REQUESTED c~ <br />.. <br /> <br />c=J RESTAURANT & HEALTH DEPARTMENT APPROVAL <br />j( eJvculR P({J<,/L1hY Iv r <br />SQUARE FOOTAGE <br /> <br />HEIGHT <br /> <br />DESCRIPTION OF WORK <br /> <br />o ELECTRICAL <br />o PLUMBING <br />o MECHANICAL <br /> <br />AMP SERVICE <br /> <br />o Progress Energy 0 <br /> <br /> <br />() <br /> <br />o BUILDING <br /> <br />$ <br /> <br />I ISO 0 J <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />o GAS <br /> <br />o ROOFING <br /> <br />o SPECIALTY <br /> <br />VALUATION OF MECHANCIAL INSTALLATION <br />{9 OTHER o-i"'a.1. {.....f <br /> <br />$ <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 AREAO YES 0 NO <br /> <br /> <br />SIGNATURE <br /> <br />),I-e (oV\.I-.,.",,-,,,,,,>/ <br /> <br />~ ftJ ./~J~ <br /> <br />COMPANY~ To 2 {JeveLC'I'n-r(>~', IlVC. <br />. <br /> <br />lWI-WEIt <br /> <br />(.. -1'\ <br />~'r~) <br /> <br />'-'" <br /> <br />STATE CERT OR REGIST # <br /> <br />SIGNATURE <br /> <br />* * * * * * * *0* * * * * t t ~.ti.t * * * *1)* * * * * * * *. *H.'J!' * tJ* * * * * * * * * * * * * * * * * * * * * * * * * * * <br />onna M. ....Itntl . ~ Jt{ iY,dJl..-L <br />Notary Public. ~OMPANY <br />Commission #D0307601 . <br />Expires April H~, ~nnR STATE CERT OR REGIST # <br />State of Florida <br />****************************************************-k************* <br /> <br />ELECTRICIAN <br /> <br />COMPANY <br /> <br />PLUMBER <br /> <br />STATE CERT OR REGIST # <br /> <br />SIGNATURE <br /> <br />****************************************************************** <br /> <br />COMPANY <br /> <br />MECHANICAL <br /> <br />SIGNATURE <br /> <br />STATE CERT OR REGIST # <br /> <br />**{p:-*****************:~~:~;:*ic;~* *Ih;;-;A~ c c <br /> <br /> <br />STATE CERT OR REGIST #.. 11 <br />.~ <br />",'i <br /> <br />Ow ilfc:',- <br />OTHER <br /> <br />SIGNATURE <br />