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<br />Owner's Name <br /> <br /> <br />City of Zephyrhllls Permit Application <br />Building Department <br /> <br />Fax-813-780-0021 <br /> <br />813-780-0020 <br /> <br />OWne"s Address <br /> <br />Fee Simple Titleholder Name I <br /> <br />\+t'\ <br />n\~ <br /> <br /> <br />Fee Simple Titleholder Address I o\a <br /> <br />I'5Lc4'L \2*' ~. <br />L!lle- <br /> <br />D ~ NEWCONSTR <br />~ INSTALL <br /> <br />PROPOSED USE D <br />TYPE OF CONSTRUCTION D <br /> <br />. --""""''''-''~fu-l <br /> <br />OWner Phone Number 1'15-18 a -l&AILn I <br />OWner Phone Number 18 l~ -")8".3 - taq I {P I <br /> <br /> <br />I con 113../J <br />PARCEL lOti 11- 2~ - 2J.. OOIO"O~l.Jc.o- 01'30 <br /> <br />(OBTA"ED FROII PROPERTY TAX NOTtcE) <br /> <br />o <br /> <br />D818 Received <br />..~- <br /> <br />JOB ADDRESS <br /> <br />SUBDIVISION <br /> <br />DESCRIPTION OF WORK <br /> <br /> <br />ADD/AL T <br />REPAIR <br /> <br />SIGN <br /> <br />MOVE D <br /> <br />DEMOLISH <br /> <br />WORK PROPOSED <br /> <br />o <br /> <br />BUILDING <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />D <br /> <br />ELECTRICAL <br /> <br />AMP SERVICE <br /> <br />D <br /> <br />PROGRESS ENERGY <br /> <br />o <br /> <br />WRE.C <br /> <br />DYES <br /> <br />~~ <br /> <br /> <br />o <br />o <br /> <br />PLUMBING <br /> <br />MECHANICAL <br /> <br />VALUATION OF MECHANICAL INSTALLATION <br /> <br />o <br /> <br />GAS <br /> <br />ROOFING <br /> <br />SPECIALTY D <br />FLOOD ZONE AREA <br /> <br />OTHER <br /> <br />COMPANY <br /> <br /> <br /> License # <br />~ FEE CURRENT L.r..L..!:!..J <br /> License # <br />~ FEE CURRENT L.r..L..!:!..J <br /> License # <br />l...!.!...!:U FEE CURRENT L.r..L..!:!..J <br /> License # <br />l...!.!...!:U FEE CURRENT L.r..L..!:!..J <br /> <br />- ~rA!i:_""A",.'- <br /> <br />-!:~i5~lsiii!!!iRtW <br /> <br />REGISTERED <br /> <br />ELECTRICIAN I <br />SIGNATURE . <br /> <br />Address I <br /> <br />PLUMBER I <br />SIGNATURE <br /> <br />Address I <br /> <br />MECHANICAL I COMPANY <br />SIGNATURE . REGISTERED <br /> <br />Address [ <br /> <br /> <br />~~~~~URE I ~::~':: <br /> <br /> <br />Address I License # <br />==~=-~~--~~~~---~~~-- <br />RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building P1ens; (1) set of Energy Fonns <br />Minimum ten (10) woridng days after submittal dete. Required ons~e, Constnx:tion Plans, San~ry Facil~ies & 1 dumpste(..---, <br />COMMERCIAL Attach (3) sets of Building Plans; (1) set of Energy Fonns. /' \ <br />Minimum ten (10} working days after submittal date. Required onsite, Construction Plans, Sanitary Facilites & 1 d pster <br />All commercial requirements must meet compliance. <br />SIGN PERMIT Attach (2) sets of Engineered Plans. <br />--PROPERTY SURVEY required lor all NEW constnx:tion. <br />~~:2'L'-'--::_.,"::::-~~~~~~.~~....emt~~~~~~~~~~ <br />Directions: <br />Fill out application completely. <br />Owner & Contractor sign back of application, notarized <br />If ""er $2500, a Notice of Commencement is required. (AlC upgrades over $5000) <br /> <br />Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized lette <br /> <br />COMPANY <br /> <br />REGISTERED <br /> <br />COMPANY <br />REGIS1ERED <br /> <br />OVER THE COUNTER PERMITTING (Front of Application Only) <br />Reroofs Se_rs Service Upgrades AlC <br /> <br />Driveways <br /> <br />