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<br />MAR/31/2005/THU 11:40 AM ZEPHYRHILLS BUILDING FAX No. 8\3-780-002\ <br /> <br />CITY OF ZEPHYRHILLS PERMIT APPLICATION <br />BUILDING DEPARTMENT 5335 8,"B St, Zephyrhi11.s, l!"L 33542 <br />813-780-0020 FAX: 813-780-0021 <br /> <br />p, 002 <br /> <br />DATE Rli:CE IVED <br /> <br />~~ Co~fG(e\~lIr-- - <br />a~t:"h~'/~(-rM <br /> <br />913 - 7~Cj -5;1.77 <br />ey...J. /il3$ <br />'l! 13 .~ 7 (/j - .5 .1,:71 <br /> <br />PHONE CONTACT FOR PERMITTING <br /> <br />lJS <br />JOB ADDRESS '16 5lf <br /> <br />Le...^^otl <br />,,/,) r <br /> <br />PHONE <br /> <br />O~NER'S NAME <br /> <br />BLOCK <br /> <br />SUBDIVISION <br /> <br />Cte5/V~\rl 1-h\II~ <br /> <br />LEGAL DESCRIP~IO~: LOT(S) <br />PARCEL ID * . <br /> <br />WORK PROPSEO: <br /> <br />PROPOSED <br /> <br /> <br />bO <br /> <br />:::>- <br /> <br />RT <br /> <br />N <br /> <br />M <br /> <br />o REPAIR <br /> <br />o INSTALL <br /> <br />o ADDITION <br /> <br />o ALTERATION <br />o DEMOLISH <br /> <br />DSIGN <br />USE~GL FAMILY <br />o COMMERCIAL <br /> <br />o MOVE <br /> <br />DMULTI-FAMILY <br />o IND,USTRIAL <br /> <br />0,. OF UNITS <br />o SWIMMING POOL <br /> <br />o MOBILE flOME <br />o OTHER <br /> <br />DWELLING <br /> <br />C:J RESTAURANT <br />eW sfR.. <br /> <br /> <br />BUILDING SIZE <br /> <br />DESCRI~rON OF WORK <br /> <br />SQUARE FOOTAGE <br /> <br />z~;6 <br /> <br />HEXGHT <br /> <br />RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY ~ORMS. <br />COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. <br />IF SrGN PERM~T ONLY (2) SETS OF ENGINEERED PLANS REQUIRED. <br />PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. <br /> <br />M BUILDING <br />o ELECTRICAL <br /> <br />o PLOMBING <br />o MECHANICAL <br /> <br />PERMITS REQUESTED <br /> <br />c; V;z ?J <br /> <br />$ /26/ b,9-~~ <br />, <br />ZC.:::r::? <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />~f <br /> <br />o <br /> <br />AMP SERVICE <br /> <br />W.R.E.C, <br /> <br />Progress Energy <br /> <br />$ <br /> <br />VALUATION 6~ MECHANCIAL INSTALLATION <br /> <br />o GAS 0 ROOFING 0 SPECIALTY <br />TYPE OF CONSTRUCTION~BLOCK <br />FINISHED ~LOO~ ELEVATIONS <br /> <br />o OTHER <br /> <br />o FRAME <br /> <br />o STEEL <br /> <br />o OTHER <br /> <br />IS PROJECT IN FLOOD ZONE AREAD YES <br /> <br />~O <br /> <br /> <br />BUILDER <br />SIGNA;UtE <br /> <br />llLECTRICIAN <br /> <br />SIGNATURE <br /> <br />~UMBER <br /> <br />SrGNATURE <br /> <br />MECHANXCAL <br /> <br />SIGNATURE <br /> <br />STATE CERT OR REGIST I Ci3CIZS/rf-4l... <br /> <br />.*********.******.*********************.~*******.**.~************. <br /> <br />COMPANY tA~~ P.:tSl.o <br /> <br /> <br />ii)dDc <br />e.RoO \ LfSOl' <br /> <br />STATE CERT OR REGIST i <br /> <br />******************.***************************~ <br /> <br />COMPANY I)" ~ LollI'- plolM~l"e <br />STATE CERT OR REGIST # C. F'C l-t: ~ {.;)-'1 <br /> <br />****...*********.******~*:***;1b******r.*** <br />COMPANY. p' "I::' ()~ A ~. . <br />STATE CERT OR REGIST # CA-<:--C>5'b If( (:) <br /> <br />OTHER <br /> <br />~~;:~""~"""""""":;~P::::"~::;~i;;~""""" <br /> <br />SIGNATURE _d _ STATE CERT OR REGIST * CC -('05799 I <br />