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<br />Date Received <br /> <br /> <br />City of Zephyrhllls Permit Application <br />Building Department <br /> <br />FaX-813-780-002.1"71J1A. . <br />:Wl.7' J <br /> <br />813-780-0020 <br /> <br />Owner Phone Number I.. - I <br />Owner's Name ~ I ' i <br />0Wn.Mdd...5 I -;; If 1,' I iJ. f t, ":>7: ! OWner Ph.", Numbo. f I ~- 7 /1'-1 ~ S- 3 <br /> <br />F.. S'mpl' TII,.h.lder .":.l5c. ;; L. -rt1-J,bqr~ A. I<'('di~r~. Ph." Numbo. I s4dl L <br /> <br />F.. Simp" TIII.h.'do. Add""s1 \ 3'(.3 ~ ~fJJ - .: -r -. . I <br />JOB ADDRESS I c._ 'f 3 . / __It ~. , I lOU I <br />I - I PARCEL 'DO [ I t- :lip . aJ.l- (!OlD';" .3700 -(b$O I <br />(qaT AINED FROM PROPERTY TAX NOTICE) <br />D NEW CONSTR B ADO/ALT 0 SIGN D. MOVE 0 <br />D INSTALL REPAIR ..12 <br />PROPOSED USE 0 SFR 0 COMM [f] OTHER L ~ €.1L6lf{) <br />TYPE OF CONSTRUCTION 0 BLOCK 0 FRAME 0 STEEL 0 OTHER I <br /> <br />DESCRlPT'ON OF WORK 111 L S !I;fJJ /.... ~ <:> 1)+' (t:;-Xf. {lOa r- <br /> <br />~~~~.'~:.~:~~.", ,I.e. :(..r. r.?',:,!..,., ~~ .~~~~~?~!., !([~"......,!.... ~~~?~.],..! Fe.,...,., I"..",..",..,.".." I <br />o BUILDING 1$ II DD ~ I VALUATION OF TOTAL CONSTRUCTION <br />o ELECTRICAL 1$ I AMP SERVICE 0 PROGRESS ENERGY <br />o PLUMBING 1$ I <br />o MECHANICAL 1$ I VALUATION OF MECHANICAL INSTALLATION <br /> <br />o GAS D ROOFING ~ SPECIALTY 0 OTHER <br />FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO <br /> <br />~~:~~~~"IIIIIJ~:llllj~"'II"'IIII""I~~~::~lli"""""""""""""""""""""""""""""', <br /> <br />SIGNATURE . _ ___ _ . REGISTERED I 1f/6N"j ~ ~~~~ Y / N <br />Address I license # I I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />SUBDIVISION <br /> <br />DEMOliSH <br /> <br />WORK PROPOSED <br /> <br />: <br />I <br /> <br />o <br /> <br />W.R.E.C <br /> <br />COMPANY <br />REGISTERED <br /> <br />ELECTRICIAN <br />SI~NATURE <br /> <br />Y/N <br /> <br />FEE CURRENT <br /> <br />Y/N <br /> <br />Address <br /> <br />license # <br /> <br />COMPANY <br />REGISTERED <br /> <br />PLUMBER <br />SIGNATURE <br /> <br />Y/N <br /> <br />FEE CURRENT <br /> <br />Y/N <br /> <br />Address <br /> <br />license # <br /> <br />COMPANY <br />REGISTERED <br /> <br />MECHANICAL <br />SIGNATURE <br /> <br />Y/ N <br /> <br />FEE CURRENT <br /> <br />yrN <br /> <br />Address <br /> <br />license # <br /> <br />OTHER <br />SIGNATURE <br /> <br />COMPANY <br />REGISTERED <br /> <br />I Y IN <br /> <br />FEE CURRENT <br /> <br />Y/N <br /> <br />COMMERCIAL <br /> <br />Address license # <br />11111111111111111111111111111111111111' 111111111111111111111111I111111111111111 i IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIJ 111111111I11111 <br />RESIDENTIAL Attach (2) Plot Plans; (2) sf;lts of Building Plans; (1) set of Energy Forms <br />Minimum ten (10) working days atter submittal date, Required onsite. Construction Plans. Sanitary Facilities & 1 dumpster <br />Attach (3) sets of Building Plans; (1) set of Energy Forms. <br />Minimum ten (10) working days atter submittal date. Required onslte. Construction Plans, Sanitary Facilities & 1 dumpster <br />All commercial requirements must meet compliance. <br />Attach (2) sets of Engineered Plans. <br />....PROPERTY SURVEY required for all NEW construction. <br />11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 U 1111111 <br />Directions: . . i <br />Fill out application completely. <br />Owner & Contractor sign back of application. notarized <br />If oyer $2500, a Notice of Commencement Is required. (AlC upgrades over $5000) <br /> <br />.., Agent (for the contractor) or Power of Attomey (for the owner) would be someone with notarized letter from owner authorizing sam.!ll..., <br /> <br />OV~. .R UNTER PERMITTING (Front of Application Oniy) <br />~ Sewers Service Upgrades AlC Driveways Fences (PlotJSurvey/Footag~! <br /> <br />SIGN PERMIT <br /> <br />