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<br />I <br />813-78C-0020 <br /> <br />City of Zephyrhills Permit Application <br />Building Department <br /> <br />Fax-813-780-0021 <br /> <br />Date Received <br /> <br /> <br /> <br />'0 \ \ ~ 0 <br />lJ,- I <br />Owner's Address ,I /() 51. I II <br />Fee Simple Titleholtler Namel <br /> <br />Owner's Name <br /> <br />I <br /> <br />LUj~ <br />PI <br /> <br />LJ- <br /> <br />/lIJ-/?O <br /> <br />715"3 <br />'.) ~ - t'1 '?, ") <br />Owner Phone Number 13 S 2- - ') <0 ')- ('If 3. <br />Owner Phone Number 19<//- V 7 J -,j <f 0 <br /> <br />Fee Simple Titlehol~er Address I <br /> <br />JOB ADDRESS <br /> <br />/If/ II <br /><.,) Jl111 <br /> <br />SUBDIVISION <br /> <br /> <br />C\<6\ <br /> <br />PARCEL ID#I ~ y, ~<.o - ~, - Ot>30 00000 <br />(OBTAINED FROM PROPERTY TAX NOTICE) <br />SIGN D MOVE D <br /> <br />WORK PROPOSED <br /> <br />ADD/AL T <br />REPAIR <br />COMM <br />FRAME <br /> <br />DESCRIPTION OF WORK <br /> <br /> <br />m--- <br /> <br />BUILDING <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />W.R.E.C. <br /> <br />czl <br />c:::::v-- <br />c:::a--- <br /> <br />ELECTRICl:AL <br /> <br />AMP SERVICE <br />(0u <br /> <br />PLUMBING <br /> <br />MECHANICAL <br /> <br />VALUATION OF MECHANICAL INSTALLATION <br /> <br />BUILDER <br />SIGNATURE <br /> <br /> <br />Address <br /> <br />ELECTRICIAN <br />SIGNATURE <br /> <br />Address <br /> <br />PLUMBER <br />SIGNATURE <br /> <br />I~ <br /> <br />COMPANY <br />REGISTERED <br /> <br />Address <br /> <br />MECHANICAL <br />SIGNATURE <br /> <br />Address <br /> <br />OTHER <br />SIGNATURE <br /> <br />COMPANY <br />REGISTERED <br /> <br />COMMERCIAL <br /> <br />SIGN PERMIT <br /> <br />LOT # <br /> <br />1/70 <br />liDO <br /> <br />D <br />D <br />D <br /> <br />DEMOLISH <br /> <br />I <br />D <br /> <br />OTHER <br />STEEL <br /> <br />OTHER I <br /> <br />~ PROGRESS ENERGY <br /> <br />D <br /> <br />L}~~f~EC~RE~LEf yf~1 <br /> <br />License # I r +\ O<::xJc> <';c)'-/ <br /> <br />C Lee <br />FEE CURRENT <br /> <br />L~C <br />I@N I <br /> <br />IlJ) N I <br /> <br />License # I Cc.-/.xjo 7J> 6 5 <br /> <br />I tJS ff 4=U st4 c E--5' . <br />I Y I tf) FEE CURRENT I Y tfJ) I <br /> <br />License # LtJj- <.) <DO ~ () y <br />~((V1(/' AI/ <br />~I N I FEE CURRENT 6)N I <br />License # I C Il-C0S7/1 g- <br />I <br /> <br />YI N <br /> <br />Y/N <br /> <br />FEE CURRENT <br /> <br />I....IIII..IIIIIIII.!.I......IIII...IIIIIIIIIIIIIIII.I1111111..,11.11.......11...................11111......11111......111........11.11111.11...... <br />Directions: <br />Fill out applicati n completely. <br />Owner & Contra tor sign back of application. notarized <br />If over $2500, a Notice of Commencement Is required. (AlC upgrades over $5000) <br /> <br />Agent (for the c ntractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same <br /> <br />OVER THE COUNT R PERMITTING (Front of Application Only) <br />Reroofs Sewers Service Upgrades AlC Fences (PloUSurvey/Footage) <br /> <br />Driveways-Not ver Counter if on public roadways..needs ROW <br />