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<br />Owner's Name
<br />
<br />
<br />~~,~~
<br />
<br />1-','1 0'/
<br />Dl}v i V
<br />
<br />City of Zephyrhills Permit Application
<br />Building Department ~ t R
<br />
<br />f513
<br />
<br />Fax-813-78u-uu;.n
<br />
<br />813-780-0020
<br />
<br />Date Received
<br />
<br />
<br />
<br />Owner Phone Number
<br />
<br />Owner Phone Number I
<br />
<br />Owner Phone Number I
<br />
<br />Owner's Address
<br />
<br />Fee Simple Titleholder Namel
<br />
<br />Fee Simple Titleholder Address I
<br />
<br />6:< k~ ;t6fJClI
<br />
<br />6'flJ17c tJ De
<br />PARCELlD#1
<br />
<br />LOT # I $, I~ 8
<br />
<br />JOB ADDRESS
<br />
<br />E1
<br />
<br />PROPOSED USE D
<br />
<br />TYPE OF CONSTRUCTION D
<br />
<br />DESCRIPTION OF WORK 11-1 E ;;-r
<br />
<br />BUILDING SIZE I I sa FOOTAGE I HEIGHT I
<br />III r , III1IIIIIII111 , II , 1III , 111111111111111111111111111111111111111 , , I III1III1II J 1IIII , III . IIIIII IIIIII , 111111111111111 , IIII , III , IIIIIII " 111111 , I
<br />
<br />1$ I
<br />D ELECTRICAL 1$ I
<br />D PLUMBING 1$ I
<br />
<br />D MECHANICAL 1$ 1.1 c: r. cC:: I
<br />./) 0,..,0. .-
<br />D GAS D ROOFING D SPECIALTY D OTHER
<br />FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO
<br />" 1111 " " 11111111111111 " 111I11111111I11111 ! III " 111I1 " 1111111111I11 " II " 11111I11111111111111 " 1111111111111111111 " I" 1111111111111111111 " III
<br />
<br />:~~~RE I :.:: I Y f N FEE"'-"RENT Y f N I
<br />I
<br />I
<br />I
<br />I
<br />I
<br />I
<br />I
<br />I
<br />I
<br />
<br />NEW CONSTR
<br />INSTALL
<br />SFR
<br />BLOCK
<br />
<br />I
<br />
<br />B
<br />D
<br />o
<br />Ex H11v5/
<br />
<br />SUBDIVISION
<br />
<br />(OBTAINED FROM PROPERTY TAX NOTICE)
<br />SIGN D MOVE D
<br />
<br />DEMOLISH
<br />
<br />WORK PROPOSED
<br />
<br />ADD/All
<br />REPAIR
<br />COMM
<br />FRAME
<br />
<br />D
<br />D
<br />D
<br />
<br />OTHER I
<br />STEEL D
<br />
<br />OTHER I
<br />
<br />~c)D
<br />
<br />D
<br />
<br />BUILDING
<br />
<br />VALUATION OF TOTAL CONSTRUCTION
<br />
<br />AMP SERVICE
<br />
<br />D
<br />
<br />PROGRESS ENERGY
<br />
<br />D
<br />
<br />W.R.E,C.
<br />
<br />VALUATION OF MECHANICAL INSTALLATION
<br />
<br />Address
<br />
<br />License #
<br />
<br />ELECTRICIAN
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />FEE CURRENT
<br />
<br />Y/N
<br />
<br />Address
<br />
<br />License #
<br />
<br />PLUMBER
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />YI N
<br />
<br />FEE CURRENT
<br />
<br />Y/N
<br />
<br />Address
<br />
<br />License #
<br />
<br />~~
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />!<-t-R
<br />I Y / N
<br />
<br />Sftt:?;T Me 7T/L
<br />FEE CURRENT I Y / N I
<br />
<br />License # IRS tJo 2 if psg-
<br />
<br />MECHANICAL
<br />SIGNATURE
<br />
<br />Address
<br />
<br />OTHER
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />FEE CURRENT
<br />
<br />Y/N
<br />
<br />COMMERCIAL
<br />
<br />Address License #
<br />1111111111 " II " III " 111111111111 " 111111111111111111111111 " II " 111111I11111111I111111I " I " 11111111 " 11111 " " " 111111111I11I1 " II " " 111111 " II
<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 onsite, Construction Plans, Stormwater Plans wI Silt Fence Installed,
<br />Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisionsllarge 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 onsite, Construction Plans, Stormwater Plans w/ 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 />
<br />SIGN PERMIT
<br />
<br />DI~~~ti~~~': . . . . . . . . . . . . . . . . . . . . . , . . . . . . . , . . , . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . , 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 . I I . I I I I I I I I I I I I I . . I . . . I . .
<br />
<br />Fill out application completely.
<br />Owner & Contractor sign back of application, notarized
<br />If over $2500, a Notice of Commencement Is required. (Ale upgrades over $5000)
<br />.. Agent (for the contractor) orto,-,wer",6f~e}t1tQ, i"ml'd.U!Pt~,'~,' b6I~eone with notarized le7-.m~~r~, ,~j~"a.:,'~~", e, "",,*_.,
<br />OVER THE COUNTER PERMIr+G," .'(Froftf:Of AppltcatfohOnly). , ~. " 'i;' . ':.\>; ,;,1,"""" .< 1
<br />Reroofs Sewers " servld<<~des:,,;,.', Me. cf;l F,~ts (Plot/Survey/Footage), " ."j". ,.,.<~;,:::.~1v' Y '.~ ""1)1-
<br />
<br />Driveways-Not over counte~f$PlJblICr?ad~YS..ileedsROW~' .' ~'M;;:.:;,;,; ,,,~>...,,.,\(.:. .' . '~~l/~
<br />.,...."... . "'.. . 1-".>,,-~' -A" ,,"of (. ,1,' 1.;.,/ ~ \(' ",'~";>...").; "~.,: fI!'
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