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<br />813-780-0020
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<br />City of Zephyrhills Permit Application
<br />Building Department
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<br />Fax-813-780-0021
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<br />/ Owner's Name
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<br />Date Received
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<br />7: II: { I
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<br />Owner Phone Number
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<br />Owner Phone Number I
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<br />Owner Phone Number I
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<br />Fe. Simp" Tlllehold" Add""," LI
<br />/ JOB ADDRESS I ~ 7- ~ 1 {l 6.t
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<br />.~) h~~ lIe;'
<br />I
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<br />n NEW CONSTR 0 ADD/All 0
<br />D INSTALL D REPAIR
<br />PROPOSED USE 0 SFR 0 COMM 0 OTHER I
<br />TYPE OF CONSTRUCTION 0 BLOCK 0 FRAME 0 STEEL D
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<br />/ DESCRIPTION OF WORK 1ft') d ~ I Lld L( u 51 -'2('. $-elf' V \' e...G--
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<br />BUILDING SIZE I I SQ FOOTAGE I I HEIGHT I I
<br />TTTP'IIII'II' 11111 '11'11111111111 I1111 "II 1'11'11'11'11'1 11'1 I 11'1111 I '11111' 1111111; I 111111111111 I 11111111'1111 I 1'1111'1'1111 " 1'11'11 "1111111
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<br />:),
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<br />LOT # \
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<br />PARCEL ID#I
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<br />SUBDIVISION
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<br />'. \ _ :;2. I..v . - d \ - b (...) \ 0 - 01 lO (:; .. 0 ( lO
<br />(OBTAINED FROM PROPERTY TAX NOTICE)
<br />D MOVE 0
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<br />SIGN
<br />
<br />DEMOLISH
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<br />WORK PROPOSED
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<br />OTHER I
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<br />D
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<br />1$
<br />1$
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<br />o PLUMBING 1$
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<br />D MECHANICAL 1$
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<br />o GAS 0 ROOFING 0 SPECIALTY 0 OTHER
<br />FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO
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<br />11111111111111111111111111111111111111111111'11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
<br />
<br />VALUATION OF TOTAL CONSTRUCTION
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<br />BUILDING
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<br />/'0
<br />
<br />ELECTRICAL
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<br />AMP SERVICE
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<br />o
<br />
<br />PROGRESS ENERGY
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<br />o
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<br />W.R.E.C.
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<br />VALUATION OF MECHANICAL INSTALLATION
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<br />;' BUILDER
<br />SIGNATURE
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<br />I~ (;;~ I
<br />I
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<br />COMPANY/ I
<br />REGISTERED
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<br />~N~I~~
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<br />License # I
<br />
<br />Y/N
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<br />Address
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />ELECTRICIAN
<br />SIGNATURE
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<br />Y/ N FEE CURRENT
<br /> License #
<br />Y/N FEE CURRENT
<br /> License #
<br />Y/ N FEE CURRENT
<br /> License #
<br />Y/N FEE CURRENT
<br />
<br />Y/N
<br />
<br />Address
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />PLUMBER
<br />SIGNATURE
<br />
<br />Y/N
<br />
<br />Address
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />MECHANICAL
<br />SIGNATURE
<br />
<br />Y/N
<br />
<br />Address
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />OTHER
<br />SIGNATURE
<br />
<br />YfN
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<br />Address License #
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<br />1111111111I111 11111111111111111111111111111111111111111111I11111111111111111111111111111111111111111111111111111111I11111111111111111111111111111
<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 w/ Silt Fence installed,
<br />Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects
<br />COMMERCIAL 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 onsile, 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 />SIGN PERMIT Attach (2) sets of Engineered Plans.
<br />....PROPERTY SURVEY required for all NEW construction.
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<br />[ji~~~ti~~~':' , , , , , , , , , , , , , , , , , , , , , , . , , , , . . , , , , , , , , , , , , , , , , . , , , , , , , , , I , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , . , , , , , . , , , , , , , I
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<br />Fill out application completely.
<br />Owner & Contractor sign back of application, notarized
<br />If over $2500, a Notice of Commencement is required. (AlC upgrades over $5000)
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<br />Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
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<br />OVER THE COUNTER PERMITTING (Front of Application Only)
<br />Reroofs Sewers Service Upgrades A/C Fences (Plot/Survey/Footage)
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<br />Driveways-Not over Counter If on public roadways..needs ROW
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