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<br />813-780-0020
<br />
<br />City of Zephyrhills Permit Application
<br />Building Department
<br />
<br />t-aX-!ll j-I !lV-UUL 'I
<br />
<br />Date Received
<br />
<br />
<br />
<br />ff\J(,'
<br />
<br />Owner phone Number ~,
<br />
<br />?\II~er phone Number I
<br />I Owner Phone Nu~b~r I
<br />
<br />P~fE5 loNA-t.-5
<br />Owner's Address 112 &,0"3' LAK e...
<br />Fee Simple Titleholder NamJ L I~~
<br />
<br />Owner's Name
<br />
<br />ff , LL 5 P tz,. .
<br />p ~ Fc55 51 tJl\J/t7..S.
<br />
<br />
<br />lW3
<br />GfL.54-
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<br />/.,
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<br />F f..., ., 'Y5 C, 1
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<br />Su I 1"1::.- ~ 3 LOT# I I
<br />
<br />'PARCELlD#la'2.- 2(,:.-2.1 - OObO";' ooC Od -~al 01
<br />(OBTAINED FROM PROPERTY TAX NOTICE)
<br />if SIGN D MOVE 0
<br />
<br />ADD/All
<br />REPAIR
<br />COMM
<br />FRAME
<br />
<br />DEMOLIsH
<br />
<br />JOB ADDRESS
<br />
<br />I
<br />B'
<br />o
<br />D
<br />DESCRIPTION OF WORK ~ \J (n.;.. -+ 0- sro (0 \) ~\.
<br />~~~~~'~?, ~:~~. , , , !, . ~, ~e<? , ~., , , . . " . ,! , , ' . ~~~~,~ ~~~.. , . . " , ' , '" , " " , , , ". , , , ,,~~,'~~~ , !, ,/, ~ .', , " . , , , . .. , , , !. . , , , , . . ., '" ' , . , , , , '"
<br />
<br />Ig] BUILDING 1$ I ~ LX) ()O VALUATION OF TOTAL CONSTRUCTION
<br />
<br />D ELECTRICAL 1$
<br />
<br />D PLUMBING 1$
<br />
<br />D MECHANICAL 1$
<br />
<br />D GAS D
<br />FINISHED FLOOR ELEVATIONS I
<br />
<br />SUBDIVISION
<br />
<br />PROPOSED USE
<br />TYPE OF CONSTRUCTION
<br />
<br />B
<br />o
<br />D
<br />
<br />NEW CONSTR
<br />INSTALL
<br />SFR
<br />BLOCK
<br />
<br />o
<br />D
<br />
<br />OTHER I
<br />STEEL D
<br />
<br />WORK PROPOSED
<br />
<br />I
<br />I'
<br />
<br />OTHER I
<br />
<br />AMP SERVICE
<br />
<br />t::::J
<br />
<br />PROGRESS ENERGY
<br />
<br />D
<br />
<br />W.R.E.C.
<br />
<br />VALUATION OF MECHANICAL INSTALLATION
<br />
<br />ROOFING
<br />
<br />o
<br />I
<br />
<br />SPECIALTY D
<br />FLOOD ZONE AREA
<br />
<br />OTHER
<br />DYES
<br />
<br />DNO
<br />
<br />BUILDER
<br />SIGNA TU
<br />
<br />
<br />~\lfi-
<br />
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />IAztZ-- CoN S~ Vc..-n oJ Co ., IN(,. I
<br />I '""i!Jl. N' I FEE CURRENT I ~ N ,
<br />License # l <:::: Be- a 5' 77 fJ7 I
<br />I
<br />Y/N
<br />
<br />I
<br />I
<br />Y/N
<br />
<br />I
<br />I
<br />Y/N
<br />
<br />I
<br />I
<br />Y/N
<br />
<br />I
<br />
<br />Address
<br />
<br />ELECTRICIAN I '
<br />SIGNATURE
<br />
<br />Address I
<br />
<br />PLUMBER I
<br />SIGNATURE
<br />
<br />Address I
<br />
<br />Y/N FEE CURRENT
<br /> License #
<br />Y/ N FEE CURRENT
<br /> License #
<br />Y/ N FEE CURRENT
<br /> License #
<br />Y/N FEE CURRENT
<br /> License #
<br />
<br /> COMPANY
<br /> REGISTERED
<br />I COMPANY
<br />REGISTERED
<br />I COMPANY
<br />REGISTERED
<br />
<br />MECHANICAL
<br />SIGNATURE
<br />
<br />Address
<br />
<br />OTHER
<br />SIGNATURE
<br />
<br />Address
<br />
<br />1111111' III'" I 11111 '1111111.1' 11I11111111 '11111111,1111111111111111111' 11111111111111' 1111111111111111111111111111111 i 11111111111111 i 1111111111111
<br />RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms
<br />Minimum ten (10) working days after submittal date. Required onslte, Construction Plans, Sanitary Facilities & 1 dumpster
<br />COMMERCIAL Attach (3) sets of Building Plans; (1) liet of Energy Forms.
<br />Minimum ten (10) working days after submittal date. Required onslle. Construction Plans, Sanitary Facilities & 1 dumpster
<br />All commercial requirements must meet compliance.
<br />SIGN PERMIT Attach (2) sets of Engineered Plans.
<br />....PROPERTY SURVEY required for alj NEW construction.
<br />111111111111111111111111111111111.111111111,1111111111l'II"III,lllllllllllllllllllllillliiiillllillillllili1IIIIilillllillllillliliiiliiiiiliiliii
<br />Directions:
<br />Fill out application completely.
<br />Owner & Contractor sign back of application. notarized
<br />If over $2500, a Notice of Commencement Is required. (AlC upgrades over $5000)
<br />
<br />Agent (for the contractor) orPower of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
<br />
<br />OVER THE COUNTER PERMITTING (Front of Application Only)
<br />Reroofs Sewers Service Upgrades Ale Driveways Fences (Plot/Survey/Footage)
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