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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 />Date Received
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<br />(V.- ~'( -0 l
<br />V13 IE
<br />3 95''1/ ).),trlIYS '/ l!2A ti
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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 />Owner's Name
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<br />Owner's AddresJ-41/I{
<br />Fee Simple Titleholder Namel
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<br />Fee Simple Titleholder Address I
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<br />I 3151-/ Jt Mr If y sf LV ,4..../ 2E?lIyfJ Ifll L ~ FL I LOT # I ( II
<br />II3MeltA-L ttJlJ.)1 I PARC~L1D#I~'f-.2h-2/-0"tfV-OOOOD-111 0
<br />(OBTAINED FROM PROPERTY TAX NOTICE)
<br />o NEW CONSTR r=J ADD/ALT tXJ SIGN D MOVE D
<br />D INSTALL D REPAIR
<br />PROPOSED USE D SFR D COMM D
<br />TYPE OF CONSTRUCTION D BLOCK D FRAME D
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<br />DESCRIPTION OF WORK I ADV (joLr (JAItI' O()~/lGAD tn>tJfJ
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<br />~~:~~II~~I~~~~' III .111'1' III :.vi~, IIIIIIIIIIII~~ '~~~~~~I~ lllllllll~(~ 11111 I!' III ~~~~~~I .111111 ~ arlll' '11111111111111111' '1111111111
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<br />D BUILDING 1$ ~ I <;$'60,1 VALUATION OF TOTAL CONSTRUCTION fll; 1 ao ~
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<br />JOB ADDRESS
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<br />SUBDIVISION
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<br />WORK PROPOSED
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<br />DEMOLISH
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<br />OTHER
<br />STEEL
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<br />I
<br />D
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<br />OTHERI~~~~
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<br />FANl~
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<br />D ELECTRICAL 1$ I AMP SERVICE D PROGRESS ENERGY D W.R.E.C.
<br />jJ //+
<br /> . /
<br />D PLUMBING 1$ I 'Z P. Ap(JCDVO...Q.
<br /> ~/A t--J0C- t-.JIA-
<br />D MECHANICAL 1$ fJ/A I VALUATION OF MECHANICAL INSTALLATION
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<br />D GAS D ROOFING D SPECIALTY D OTHER
<br />FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO
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<br />Address
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<br />BUILDER
<br />SIGNATURE
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<br />License #
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<br />I ftX UVS963V
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<br />ELECTRICIAN
<br />SIGNATURE
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<br />~
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<br />A
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<br />COMPANY
<br />REGISTERED
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<br />I Y I N j..-------FEE CURRENT
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<br />Y/N
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<br />Address
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<br />License #
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<br />PLUMBER
<br />SIGNATURE
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<br />P /14.
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<br />COMPANY
<br />REGISTERED
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<br />Y I N I FE~.et1RRENT
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<br />~:~e#
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<br />Y/N
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<br />COMMERCIAL
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<br />Address
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<br />MECHANICAL I }.lV/t
<br />SIGNATURE . .,.
<br />,
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<br />Address I
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<br />~:NEJTURE I vJ/A ;::.~~~~~ Y I N I FEECURBENr'
<br />Address I ~ I
<br />I111II11111111111111I111111111111111111I111111111111111111111I1111111111111I11111111111I1111II111111I111111111111I11111111II1111111111111111111111
<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 onsile, Construction Plans, Stormwater Plans wI Silt Fence installed,
<br />Sanitary Facilities & 1 dumpster; Site Work Permit for subdlvisionsllarge 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 wI Silt Fence installed,
<br />Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance
<br />Attach (2) sets of Engineered Plans.
<br />"--PROPERTY SURVEY required for all NEW construction.
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<br />COMPANY
<br />REGISTERED
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<br />YI N I FEEC~
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<br />~I
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<br />Y/N
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<br />Y/N
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<br />SIGN PERMIT
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<br />DI~~~~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 NC Fences (PloUSurvey/Footage)
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<br />Driveways-Not over Counter if on public roadways..needs ROW
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