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<br />1 I <br /> <br />CITY O~ ZEPHYRHILLS PERMIT APPLICATION <br />BUILDING bEPARTMENT 5335 8TH St, Zephyrhills, FL 33542 <br />813-780-0020 FAX: 813-780-0021 <br /> <br />DATE RECEIVED <br /> <br />~~s <br /> <br /> <br />PHONE CONTACT FOR PERMITTING 94/-~38-735C:. <br />~ <br /> <br />OWNER'S NAME <br /> <br />PHONE S/..3 - 7$0 ~ J76 7 3 <br /> <br />JOB ADDRESS <br /> <br />LEGAL DESCRIPTION: LOT(S) <br /> <br />BLOCK <br /> <br />SUBDIVISION <br /> <br />PARCEL 10 # <br /> <br /> <br /> <br />WORK PROPSED: <br /> <br />o ADDITION <br /> <br />OALTERATION <br /> <br />o REPAIR <br /> <br />o INSTALL <br /> <br />o SIGN <br /> <br />o MOVE <br /> <br />o DEMOLISH <br /> <br />PROPOSED USE: OSGL FAMILY <br /> <br />o COMMERCIAL <br /> <br />OMULTI - FAMIL Y <br />o INDUSTRIAL <br /> <br />0# OF UNITS <br />o SWIMMING POOL <br /> <br />o MOBILE HOME <br />prr OTHER <br /> <br />& HEALTH DEPARTMENT APPROVAL <br /> <br />BUILDING SIZE <br /> <br />SQUARE FOOTAGE <br /> <br />HEIGHT <br /> <br />RESIDENTIAL: ATTACH (2) PLOT <br />COMMERCIAL: ATTACH (3) SETS <br />IF SIGN PERMIT ONLY (2) SET <br />PROPERTY SURVEY <br /> <br />PLANS & (2) SETS OF BUILDING PLANS <br />OF BUILDING PLANS & (1) SET ENERGY <br />OF ENGINEERED PLANS REQUIRED. <br />REQUIRED FOR ALL NEW CONSTRUCTION. <br /> <br />& (1) SET ENERGY FORMS. <br />FORMS. <br /> <br />PERMITS REQUESTED <br /> <br />o BUILDING <br /> <br />$ <br /> <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />o ELECTRICAL <br /> <br />o GAS <br /> <br />o ROOFING <br /> <br /> AMP SERVICE 0 Progress Energy 0 W.R.E.C. <br /> flD <br /> OF MECHANCIAL INSTALLATION C\ <br />$ VALUATION xr ~. <br />o SPECIALTY 0 OTHER <br /> <br />o PLUMBING <br />o MECHANICAL <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 />BUILDER COMPANY <br /> <br />SIGNATURE STATE CERT OR REGIST # <br /> <br /> <br />***************** ************************************************ <br /> <br />ELECTRICIAN COMPANY <br /> <br />SIGNATURE STATE CERT OR REGIST # <br /> <br />****************************************************************** <br /> <br />PLUMBER <br /> <br />COMPANY <br /> <br />SIGNATURE <br /> <br />STATE CERT OR REGIST # <br /> <br />****************** <br /> <br />*********************************************** <br /> <br />MECHANICAL <br /> <br />COMPANY <br /> <br />SIGNATURE <br /> <br />STATE CERT OR REGIST # <br /> <br />***************** <br /> <br />*********************************************** <br />r . <br /> <br />COMPANY R ~,L A e<. /fo-l-ec.:A 0..,) <br /> <br />OTHER <br /> <br /> <br />STATE CERT OR REGIST #~)05"d. 3c5Jt)o/9 9'; <br /> <br />SIGNATURE <br />