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<br />CITY OF ZEPHYRHILLS PERMIT APPLICATION <br /> <br />BUILDING DEPARTMENT 5335 8TH St, Zephyrhills, FL 33542 <br />813-780-0020 FAX: 813-780-0021 ) ;:2 <7~"'\ - <br />DATE RECE IVED - C> --d6 <br /> <br />PHONE CONTACT <br /> <br />FOR iP.AOOD'PeflMIT SI;RVICF <br />'1 -866-824-7894 <br />Toll Free <br /> <br />PHONE <br /> <br />OWNER'S NAME <br /> <br />Ilu.rJ Polls <br />t1 S- 901f <br /> <br />,c~/'~J"f U/Je- <br />LEGAL DESCRIPTION: LOT(S) IS BLOCK <br />PARCEL ID # f() -tJ..{, -cU- 0//0- 000<>>- O/SO <br /> <br />JOB ADDRESS <br /> <br />SUBDIVISION. Fdr-NI- j/i/llb/ <br /> <br />(OBTAIN FROM PROPERTY TAX NO\ICEl <br /> <br />o SIGN <br /> <br />y{ADDITION <br />o MOVE <br /> <br />oALTERATION <br /> <br />o REPAIR <br /> <br />o INSTALL <br /> <br />WORK PROPSED: oNEW CONSTRUCTION <br /> <br />o DEMOLISH <br /> <br />PROPOSED USE: []SGL FAMILY DWELLING <br />[]COMMERCIAL <br /> <br />[]MULTI-FAMILY <br />[] INDUSTRIAL <br /> <br />0# OF UNITS <br />[] SWIMMING POOL <br /> <br />[] MOBILE HOME <br />o OTHER <br /> <br />c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL <br /> <br />DESCRIPTION OF WORK <br /> <br />I~ ]( /.). <br /> <br />room tLrL/J I-JO~ <br />SQUARE FOOTAGE /'II./p <br /> <br />HEIGHT <br /> <br />BUILDING SIZE <br /> <br />ItL y:/~ <br /> <br />RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS <br />COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY <br />IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED. <br />PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. <br /> <br />& (1) SET ENERGY FORMS. <br />FORMS. <br /> <br />PERMITS REQUESTED <br /> <br />/'-12, )"c <br />~\ ~~ <br />, l Co, <br />I, ~l/ <br /> <br />f'7LvG, <br />~c. <br />IlrtJ% o.f <br /> <br />f'/J. BUILDING <br />~ ELECTRICAL <br />[] PLUMBING <br />[] MECHANICAL <br /> <br />$ <br /> <br />/J.IJOO.oO <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />AMP SERVICE <br /> <br />[] Progress Energy [] <br /> <br />W.R. <br /> <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: [] BLOCK <br /> <br />[] FRAME <br /> <br />o STEEL <br /> <br />[] OTHER <br /> <br />1f 3<6f?- <br /> <br />FINISHED FLOOR ELEVATIONS <br /> <br />IS PROJECT IN FLOOD ZONE AREAo YES 0 NO <br /> <br /> <br />BUILDER <br /> <br />COMPANY <br /> <br />tL1{)JtI <br /> <br />UlMk ~ .j i()/J <br /> <br />SIGNATURE <br /> <br />vlu.t!u, ~C <br /> <br />STATE CERT OR REGIST # <br /> <br />****************************************************************** <br /> <br />STATE CERT OR REGIST # <br /> <br />~ees ~;;] ech,~c:.-r...t ~((. <br /> <br />It{ 401 <br /> <br />ELECTRICIAN <br />SIGNATURE ~\}~\~ ~ <br /> <br />COMPANY <br /> <br />****************************************************************** <br /> <br />PLUMBER <br /> <br />COMPANY <br /> <br />SIGNATURE <br /> <br />"v/4 <br /> <br />STATE CERT OR REGIST # <br /> <br />****************************************************************** <br /> <br />MECHANICAL <br /> <br />COMPANY <br /> <br />SIGNATURE <br /> <br />N/A- <br /> <br />STATE CERT OR REGIST # <br /> <br />***************************************************************** <br /> <br />OTHER <br /> <br />COMPANY <br /> <br />SIGNATURE <br /> <br />STATE CERT OR REGIST # <br />