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813-780-0020 City of Zephyrhills Permit Application Building Department Fax-813-780-0021 Date Received IS 6A IJ 12- Owner Phone Number Owner Phone Number I Owner Phone Number I Owner's Name Owner's Address I Fee Simple Titleholder NamJ Fee Simple Titleholder Address I ~J IS' p~L. j/L1t rz. JOB ADDRESS LOT # WORK PROPOSED D _ NEW CONSTR ~. INSTALL D SFR D BLOCK I f( rC PARCEL ID#I j.J. -db -0<1 - 0030 -OOY:JO - Oi 20 (OBTAINED FROM PROPERTY TAX NOTICE) SIGN D MOVE D I CJ ADD/All D CJ REPAIR D COMM D D FRAME D RCD~/;V ~ C 12-~ [YJ 1/6 IC / ') ?) BUILDING SIZE I I SQ FOOTAGE I I 11.111.....11........11...............11................11.111..1111......11...........1111.........11.......11..11.........111.111...'.....111.11 SUBDIVISION DEMOLISH PROPOSED USE TYPE OF CONSTRUCTION OTHER I STEEL D OTHER I I I I DESCRIPTION OF WORK HEIGHT D BUILDING :: ~L! (' f) ~ ~ : VALUATION OF TOTAL CONSTRUCTION I D / D PROGRESS ENERGY D W.R.E.C. ELECTRICAL AMP SERVICE D PLUMBING 1$ I D MECHANICAL 1$ I VALUATION OF MECHANICAL INSTALLATION D GAS ~ ROOFING D SPECIALTY D OTHER FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO ..1..........11.11111111..11111111.111111.....................11...111.....11........,.......111.11...........111..11....11......111,.....'.1111.. BUILDER SIGNATURE COMPANY REGISTERED Y/N FEE CURRENT License # Y/N FEE CURRENT License # Y/N FEE CURRENT License # Y/N FEE CURRENT Y/N Address ELECTRICIAN SIGNATURE COMPANY REGISTERED Y/N Address PLUMBER SIGNATURE COMPANY REGISTERED Y/N Address MECHANICAL SIGNATURE COMPANY REGISTERED Y/N c--/2I (~ Address OTHER SIGNATURE COMPANY REGISTERED FEE CURRENT pf) 621. JJ~J D<C, ;LS'j,)2~ I License # lfC-eVtJ'-!f,2J!1 I IIIII..'Ittll'."I.'.llrtlllll"",III'IIIIII'III,I'111'111'.'1111'1"1111'1111..'111"1111."1111"'111...'11'..'111';'1111'11111 Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Sanitary Facilities & 1 dumpster Attach (3) sets of Building Plans; (1) set of Energy Forms. Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Sanitary Facilities & 1 dumpster All commercial requirements must meet compliance. Attach (2) sets of Engineered Plans. ....PROPERTY SURVEY required for all NEW construction. Address I.''''P.'IIIIII RESIDENTIAL COMMERCIAL SIGN PERMIT IIIIII!IIII&~III~IIII.IIIIIIIIIIJIIIIIIIIIIII..IIIIIII&IIIIII.IIII&IIII~IIIII.III~~IIIIIII.IIIII.III~I.III&.1lllllillllll.IIIIIIIII'illilillllllii Directions: Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement Is required. (AlC upgrades over $5000) .. Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs Sewers Service Upgrades NC Driveways Fences (Plot/Survey/Footage)