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<br />8"3-780-0020
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<br />City of Zephyrhills Permit Application
<br />Building Department
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<br />r-ax-o 1"-fOV-VU": I
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<br />'0 0 J-.:)I'->O-.
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<br />Date Received
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<br />Owner's Name
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<br />Owner's Address
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<br />Fee Simple Titleholder Namel S ~ t.
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<br />Owner Phone Number
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<br />Owner Phone Number I
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<br />Owner Phone Number L
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<br />I 1--11- r; d
<br />D NEW CONSTR [=:J
<br />D INSTALL D
<br />DSFR D
<br />TYPE OF CONSTRUCTION D BLOCK D
<br />DESCRIPTION OF WORK I S 1-+tZ:: LA..) 0 n.IC
<br />ISQ FOOTAGE I
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<br />JOB ADDRESS
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<br />SUBDIVISION
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<br />WORK PROPOSED
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<br />PROPOSED USE
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<br />BUILDING SIZE
<br />
<br />D
<br />
<br />D
<br />D
<br />D
<br />
<br />
<br />1
<br />I
<br />I
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<br />D
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<br />-1$ )j3/cJ.l(;5"
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<br />,
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<br />1$
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<br />1$
<br />
<br />1$
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<br />D GAS D
<br />FINISHED FLOOR ELEVATIONS I
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<br />ELECTRICAL
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<br />PLUMBING
<br />
<br />MECHANICAL
<br />
<br />ROOFING
<br />
<br />I-OT#
<br />
<br />ADD/ALT
<br />REPAIR
<br />COMM
<br />FRAME
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<br />D SIGN D
<br />D OTHER
<br />D STEEL D OTHER I
<br />yY\f{\'Ull [6,^^\l \?jL
<br />I HEIGHT _ '
<br />
<br />DEMOLISH
<br />
<br />-10("
<br />
<br />VALUATION OF TOTAL CONSTRUCTION
<br />
<br />AMP SERVICE
<br />
<br />D
<br />
<br />D
<br />,tJ:U50 5~
<br />AcM1"P65
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<br />PROGRESS ENERGY
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<br />W.R.E.C,
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<br />VALUATION OF MECHANICAL INSTALLATION
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<br />SPECIALTY D OTHER
<br />FLOOD ZONE AREA DYES CJNO
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<br />I ~ , I , I . I I , . .'1 , , . I I I I . , P I I , , I I I , pit' . . . I . I I , I , I I . I I , , , I . I , , . I I , , I I I , , . . I . , , , , I I . , I I . I I . I I . . . , . I I . . . , I I I . I II I I I . I , , I II , , , I I I I . I . I I I , , I " I I I , I I I , I . . .
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<br />5r-t E:.-
<br />BUILDER
<br />SIGNATURE
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<br />Address I License # I I
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<br />~,;rE:. COMPANY I ~t!J C 6"-,,,-1-6 A lOt-' 'S.o e lJlL /;:51
<br />SIGNATURE REGISTERED .__ I FEE CURRENT I GYN I
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<br />Address I d~ \ \ D S rz 5Y H-10l0 1-\)17 A,3 \~to3~. License # ICGG h5 '4 J 92- I
<br />111111111111111111111111111;11111111111111111111111111111111111111111I1111111111111111111111111111111111111111111111111111111111111111111111111111
<br />RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permit for new construction,
<br />Minimum ten (10) working days after submittal date. Required onsile, Construction Plans, Slormwater Plans wI Silt Fence Installed,
<br />Sanitary Facilities & 1 dumpster; Site Work Permit for subdivlslonsllarge projects
<br />Attach (3) sets of Building Plans; (1) set of Energy Forms. R-O-W Permit for new construction.
<br />Minimum ten (10) working days after submittal date. Required onslte, Construction Plans, Stormwater Plans wI Silt Fence Installed,
<br />Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance
<br />Attach (2) sets of Engineered Plans.
<br />....PROPERTY SURVEY required for all NEW construction.
<br />1I11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 i i 111111111111 i 11I1III i II i I i 1IIIIII1I1I11111111I11111II
<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 />.. Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
<br />OVER THE COUNTER PERMITTING (Front of Application Only)
<br />Reroofs Sewers Service Upgrades NC
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<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />YI N
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<br />FEE CURRENT
<br />
<br />Address
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<br />License #
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<br />ELECTRICIAN
<br />SIGNATURE
<br />
<br />Address
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />YI N
<br />
<br />FEE CURRENT
<br />
<br />License #
<br />
<br />PLUMBER
<br />SIGNATURE
<br />
<br />Address
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />Y I N
<br />
<br />FEE CURRENT
<br />
<br />License #
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<br />MECHANICAL
<br />SIGNATURE
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<br />COMMERCIAL
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<br />SIGN PERMIT
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<br />Driveways-Not over Counter if on public roadways..needs ROW
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
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<br />Y IN
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<br />FEE CURRENT
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<br />Fences (PloVSurvey/Footage)
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