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<br />Date Received
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<br />Owner's Name
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<br />
<br />City of Zephyrhills Permit Application
<br />Building Department
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<br />r-ax-/j I "-(/jU-uu.<: I
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<br />81a-780-0020
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<br />Owner's Address
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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 />Fee Simple Titleholder Name
<br />
<br />
<br />Fee Simple TlSeholde, Add",," ,_.
<br />JOB ADDRESS 1\ \) SD
<br />
<br />WORK PROPOSED
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<br />NEW CONSTR
<br />INSTALL
<br />SFR
<br />BLOCK
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<br />~Sf\~ \b"L\)~ I LOT# I
<br />I PARCEL ID#I36' -d6-~\ - bO\ \) ., \ D~Ot)- tJ:S:>O
<br />(OBTAINED FROM PROPERTY TAX NOTICE)
<br />Cl ADD/ALT D SIGN 0 MOVE D
<br />D REPAIR
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<br />DESCRIPTION OF WORK
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<br />DEMOLISH
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<br />PROPOSED USE
<br />TYPE OF CONSTRUCTION
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<br />1$ \ ~\)\)
<br />1$
<br />1$
<br />1$
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<br />~GAS D
<br />FINISHED FLOOR ELEVATIONS I
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<br />HEIGHT I
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<br />BUILDING SIZE
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<br />SQ FOOTAGE I
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<br />lAMP SERVICE D PROGRESS ENERGY
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<br />I VA~ATION O~~ECHANICAL INSTALLATION
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<br />W.R.E.C,
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<br />BUILDING
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<br />VALUATION OF TOTAL CONSTRUCTION
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<br />ELECTRICAL
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<br />PLUMBING
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<br />L.~~ ,Y":::'~-/ t
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<br />MECHANICAL
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<br />ROOFING
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<br />SPECIALTY D
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<br />OTHER
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<br />MECHANICAL COMPANY I
<br />SIGNATURE REGISTERED Y 1 N FEE CURRENT Y 1 N
<br />
<br />Address~ LIcense # I
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<br />~::.:':TURER-~"'\~ ~~= ~~~SFEE~'l\;~i1~] I
<br />1111 I~~:~::'II,~~~:;,~;~ ;,~~,i?~~ /~~~~!k1},~,~, '~~::::'~"I"'~~~ :?-S;:", '" III II ,,!
<br />
<br />RESIDENTIA,L 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 subdivisionsllarge 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 onslte, 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.
<br />I II I I III I II111111111 I 11111111111111 I I II I 11111111111111111111111111 i 1111I1111111111111I111111 i 11I11111111111111111 i 111I1I111 i III i IIII1I1I11I11I11II
<br />Directions:
<br />Fill out application completely.
<br />Owner 8, Contractor sign back of application, notarized
<br />If over $~2500, a Notice of Commencement Is required. (AlC upgrades over $5000)
<br />
<br />Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from ovlmer authorizing same
<br />
<br />OVER THE COUNTER PERMITTING (Front of Application Only)
<br />Reroofs Sewers Service Upgrades NC
<br />~ : ,. ,. . .
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />BUILDER
<br />SIGNATURE
<br />
<br />YI N
<br />
<br />FEE CURRENT
<br />
<br />Y/N
<br />
<br />Addresis
<br />
<br />LIcense #
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />ELECTRICIAN
<br />SIGNATURE
<br />
<br />YI N
<br />
<br />FEE CURRENT
<br />
<br />Y/N
<br />
<br />Addres!s
<br />
<br />LIcense #
<br />
<br />PLUMBER
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />FEE CURRENT
<br />
<br />Y/N
<br />
<br />Addres~s
<br />
<br />LIcense #
<br />
<br />COMMERCIAL
<br />
<br />--
<br />
<br />SIGN PERMIT
<br />
<br />Fences (PloVSurvey/Footage)
<br />
<br />Driveways-Not over Counter If on public roa<jways..needs ROW
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