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<br />'S13-78Q-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />City of Zephyrhills Permit Application <br />Building Department <br /> <br />Fax-813-780-0021 <br /> <br />Fee Simple Tltleh Ider Address 'l <br /> <br />1t70S1 PftJtr-/'5f zep/l <br /> <br />I <br /> <br /> <br />I <br /> <br />~ NEW CONSTR rd <br />D INSTALL U <br />DSFR 0 <br />o BLOCK 0 <br /> <br />DESCRIPTION 0 WORK r .U/ A'..) R ~ ~ t? )'Yl <br /> <br />/ IX 7' ,I SQFOOTAG~I <br /> <br />1$ z .t3 d CJ.. 06 <br /> <br />1$ <br /> <br />1$ /, 2..~ Of!) <br /> <br />1$ <br /> <br />o <br /> <br /> <br />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 />Attach (3) 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 />All commercial requirements must meet compliance. <br />Attach (2) sets of Engineered Plans. <br />""PROPERTY SURVEY required for all NEW construction. <br /> <br />JOB ADDRESS <br /> <br />SUBDIVISION <br /> <br />WORK PROPOS <br /> <br /> <br />PROPOSED USE <br />TYPE Of CONST <br /> <br />~UILDlNG SIZE <br /> <br />~ <br /> <br /> <br />G <br /> <br />o <br />o <br />o <br />o <br /> <br />ICAL <br /> <br />MECH NICAL <br /> <br />GAS <br /> <br />BUILDER <br />SIGNATURE <br /> <br />Address <br /> <br />PLUMBER <br />SIGNATURE <br /> <br />Address <br /> <br />MECHANICAL <br />SIGNATURE <br /> <br />Address <br /> <br />OTHER <br />SIGNATURE <br /> <br />Address <br /> <br />RESIDENTIAL <br /> <br />COMMERCIAL <br /> <br />SIGN PERMIT <br /> <br />ROOFING <br /> <br />o <br />I <br /> <br />71. 3 'J 5' <br /> <br />Owner Phone Number <br /> <br />Owner Phone Number [ <br /> <br />Owner Phone Number [ <br /> <br /> <br />LOTti l~o-,I <br /> <br />7/3 <'<'12- <br /> <br />PARCELlD#\ o~ _ g,~, Q\ - OO~D.. oD3CC- 00\ 0 <br />(qaT AINED FROM PROPERTY TAX NOTICE) <br />SIGN 0 MOVE D <br /> <br />DEMOLISH <br /> <br />ADD/ALT <br />REPAIR <br />COMM <br />FRAME <br /> <br />OTHER I <br />STEEL 0 <br /> <br />OTHER L <br /> <br />I R" -70 7' <br />HEIGHT v f c. <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />AMP SERVICE <br /> <br />o <br /> <br />PROGRESS ENERGY <br /> <br />o <br /> <br />W.R.E.C <br /> <br />VALUATION OF MECHANICAL INSTALLATION <br /> <br />SPECIALTY D <br />FLOOD ZONE AREA <br /> <br />OTHER <br />DYES <br /> <br />~O <br /> <br /> <br />~D~~ <br />I Y / N I FEE CURRENT <br /> <br />Y/N <br /> <br />License # <br /> <br />I ~()\J..-~ <br />I Y IN I . FEE CURRENT <br /> <br />License #1 <br /> <br />~CSUU'""'C\ 0 -^-- <br />I Y / N I FEE CURRENT <br /> <br />License # I <br /> <br />Y/N <br /> <br />Y/N <br /> <br />COMPANY <br />REGISTERED <br /> <br />Y / N FEE CURRENT <br /> <br />yrN <br /> <br />License # <br /> <br />COMPANY <br />REGISTERED <br /> <br />FEE CURRENT <br /> <br />Y/N <br /> <br />I YI N <br /> <br />License # <br /> <br /> <br />Directions: <br />Fill out appll tlon completely. <br />Owner & C trastor sign back of application. notarized <br />If over $25 0, a Notice of Commencement Is required. (AlC upgrades over $5000) <br /> <br />.., Agent (for e contractor) or Power of Attorney (for the owner) woulli be someone with notarized letter from owner authorizing <br /> <br />OVER THE COU TER PERMITTING (Front of Application Only) <br />'Reroofs Sewers Service Upgrades NC Driveways Fences (PlotlSurvey/Foota9 <br /> <br />