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<br />I I
<br />8B-780-00;~0
<br />
<br />City of Zephyrhills Permit Application
<br />Building Department
<br />
<br />Fax -813-780-0021
<br />
<br />Date Received
<br />
<br />
<br />
<br />...,."","
<br />
<br />Owner's Name
<br />
<br />Owner's Address
<br />
<br />4734
<br />
<br />I~ ST.
<br />
<br />Fee Simple Titleholder Namel
<br />
<br />Owner Phone Number
<br />
<br />Owner Phone Number I
<br />
<br />Owner Phone Number I
<br />
<br />Fee Simple TitleholCller Address I
<br />4'734
<br />
<br />((P 57:
<br />
<br />JOB ADDRESS
<br />
<br />SUBDIVISION
<br />
<br />I
<br />B
<br />o
<br />o
<br />
<br />WORK PROPOSED
<br />
<br />B
<br />D
<br />D BLOCK
<br />I~(: \O\\(')L \A~ ,1 t.
<br />SQ FOOTAGE I
<br />
<br />PROPOSED USE
<br />TYPE OF CONSTRUCTION
<br />
<br />NEW CONSTR
<br />INSTALL
<br />SFR
<br />
<br />DESCRIPTION OF WORK
<br />
<br />BUILDING SIZE
<br />
<br />I LOT# I
<br />
<br />PARCELlD#l/tl' z b -2/-0010- () 2& 00 - oj 0 cJ
<br />(OBTAINED FROM PROPERTY TAX NOTICE)
<br />SIGN D MOVE D DEMOLISH
<br />
<br />~~=:~ ~~ER~~ ~.
<br />
<br />ADD/ALT
<br />REPAIR
<br />COMM
<br />FRAME
<br />
<br />D
<br />D
<br />D
<br />
<br />\._00
<br />
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<br />
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<br />) 1.,(
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<br />
<br />HEIGHT
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<br />
<br />111111111111'11111"11111111111"11111111111111'111111r"IIIIIIIII.'IIIIII'.1111111111111111"IIII.1111111111111'111"11111'111111111111'111111111
<br />
<br />VALUATION OF TOTAL CONSTRUCTION
<br />
<br />I
<br />I
<br />1
<br />I
<br />o
<br />I
<br />
<br />D BUILDING 1$
<br />D ELECTRICAL 1$
<br />D PLUMBING 1$
<br />D MECHANICAL 1$
<br />D GAS D
<br />FINISHED FLOOR ELEVATIONS I
<br />
<br />ROOFING
<br />
<br />BUILDER
<br />SIGNATURE
<br />
<br />
<br />~
<br />
<br />Address
<br />
<br />(?4 'f
<br />~~
<br />5~397~
<br />
<br />'11f~
<br />d'k.
<br />~bt
<br />
<br />'tELECTRICIAN
<br />(~IGNATURE
<br />
<br />Address
<br />
<br />PLUMBER
<br />SIGNATURE
<br />
<br />Address
<br />
<br />AMP SERVICE
<br />
<br />o
<br />
<br />o
<br />
<br />W.R.E.C.
<br />
<br />PROGRESS ENERGY
<br />
<br />t\. I
<br />
<br />0"
<br />. ,
<br />
<br />VALUATION OF MECHANICAL INSTALLATION
<br />
<br />, ,,~
<br />
<br />SPECIALTY D OTHER
<br />FLOOD ZONE AREA DYES
<br />
<br />DNO
<br />
<br />
<br />
<br />1<;/
<br />COMPANY
<br />REGISTERED
<br />
<br />" -
<br />\\
<br />
<br />Y/ N
<br />
<br />FEE CURRENT
<br />
<br />----
<br />~ ~'tc.s-
<br />t"':".JJ
<br />I 3~dMPANY
<br />REGISTERED
<br />1?f-f: I
<br />
<br />I
<br />
<br />License #
<br />
<br />~"
<br />
<br />Y / N
<br />
<br />FEE CURRENT
<br />
<br />IrY/N I
<br />t ~ I 3 (JI) 32.-(5 ,
<br />
<br />License #
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />Y/ N
<br />
<br />FEE CURRENT
<br />
<br />License #
<br />
<br />MECHANICAL
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />Y / N
<br />
<br />FEE CURRENT
<br />
<br />Address
<br />
<br />License #
<br />
<br />OTHER
<br />SIGNATURE
<br />
<br />~"L ~~#
<br />
<br />111111111111111111111111111111111111111111111111111111111111111111111111111111111111I1111111111111111111111111111111111111111111111111111111111111
<br />
<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, Storm water Plans w/ Silt Fence installed,
<br />Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large 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 />I Attach (2) sets of Engineered Plans.
<br />. ....PROPERTY SURVEY required for all NEW construction.
<br />
<br />COMMERCIAL
<br />
<br />SIGN PERMIT
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />Y/ N
<br />
<br />FEE CURRENT
<br />
<br />DI~~~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. (A1C upgrades over $5000)
<br />
<br />Agent (for the dontractor) 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 ' Se)Ners Service Upgrades NC Fences (PloUSurvey/Footage)
<br />
<br />Driveways-Not ovJr Counter if on public rbadways..needs ROW
<br />
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