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<br />--- <br /> <br />CITY OF ZEPHYRHILLS PERMIT APPLICATION <br />BUILDING DEPARTMENT 5335 BTH st, Zephyrhills, FL 33542 <br />813-780-0020 FAX: 813-7BO-0021 <br /> <br />DATi: RECEIVED <br /> <br />/0 -~::J -Or <br /> <br />PHONE CONTACT FOR PERMI~~TING %/'3 ZiCf j It I <br /> <br />JOB ADDRESS <br /> <br />f(~f(1.. <br />3g'IOS <br /> <br />/JroO--frl-fiJ <br />1 <br />13 di Avl.-4<o,Z <br /> <br />[(y ~ PHONE 71/f '-- 381-0530 <br />Zet;"'1",htttJI ft. ) 'J)-Y1 <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 ID # <br />WORK PROPSED: DNEW CONSTRUCTION <br />D SIGN <br /> <br />DADDITION <br />D MOVE <br /> <br />DALTERATION <br /> <br />D REPAIR <br /> <br />o INSTALL <br /> <br />D DEMOLISH <br /> <br />PROPOSED USE: []SGL FAMILY DWELLING <br />o COMMERCIAL <br /> <br />[]MULTI-FAMILY <br />o INDUSTRIAL <br /> <br />0. OF UNITS <br />o SWIMMING POOL <br /> <br />o MOBILE HOMl <br />o OTHER <br /> <br />BUILDING SIZE <br /> <br />RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET E~RQi"FORMS. <br />COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. ..~~~.~Q <br />IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED. (> .J~, <br />PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. ~~~~~: <br /> <br />1ho3j.L.-r 9~ j\Altll'Cf,}'1'l .~I'l ~ /W,,"of'f'- "l:v ii\'i <br /><; <br />PERMITS REQUESTED ~ <br /> <br />c=J RESTAURANT & HEALTH DEPARTMENT APPROVAL <br /> <br />!?eCO-wdR PClI-klh7 JtJr <br />/ <br />SQUARE FOOTAGE <br /> <br />HEIGHT <br /> <br />DESCRIPTION OF WORK <br /> <br />[] ELECTRICAL <br />[] PLUMBING <br />[] MECHANICAL <br /> <br />AMP SERVICE <br /> <br />o Progress Energy 0 <br /> <br /> <br />D BUILDING <br /> <br />$ <br /> <br />il,fOO;) <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />$ <br /> <br />VALUATION OF MECHANCIAL INSTALLATION <br /> <br />o GAS <br /> <br />[] ROOFING <br /> <br />[] SPECIALTY <br /> <br />{9 OTHER <br /> <br />v~at{ (^-j <br /> <br />TYPE OF CONSTRUCTION: [] BLOCK <br /> <br />[] FRAME <br /> <br />[] STEEL <br /> <br />o OTHER <br /> <br />FINISHED FLOOR ELEVATIONS <br /> <br />IS PROJECT IN FLOOD ZONE AREAO YES 0 NO <br /> <br /> <br />amLDEit .rIfe CoVlI-~"'l.-rOv <br />SIGNATURE ~ 111 .Ilp)~ @ <br /> <br />COMPANy--1 r 0 2 De vel? 1'/'C'f~1 -fN"c.. <br /> <br />STATE CERT OR REGIST # <br /> <br />SIGNATURE <br /> <br />*******tfonnii~.~I~****ii~fti~~************************* <br /> <br />Notary publlcK/ C~MPANY <br />Commission #00307601, ' <br />Expires Jl.pril H~, ?nn8 STATE CERT OR REGIST # <br />State of Florida <br />****************************************************************** <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 />STATE CERT OR REGIST it <br /> <br />SIGNATURE <br /> <br />SIGNATURE <br /> <br /> <br />*****************************~******************** <br /> <br />COMPANY (2-,Ptt m#-frA,I{c-C <br />I <br /> <br />OWVldr- <br />OTHER <br /> <br />STATE CERT OR REGIST it <br /> <br />". .~ <br />.... ' <br />'v. <br />1i' <br /> <br />