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<br />813-780-0020
<br />
<br />City of Zephyrhills Permit Application
<br />Building Department
<br />
<br />Fax-813-780-0021
<br />
<br />Date Received '
<br />
<br />~ - I L( -DI
<br />
<br />
<br />Owner Phone Number
<br />
<br />cell I
<br />Owner <RhOA& Number
<br />
<br />Owner Phone Number I
<br />
<br />/ Owner's Name
<br />
<br />/ Owner's Address I (PO!J 1J
<br />Fee Simple Titleholder Namel
<br />
<br />13A1U>A1lH S. H-G~ f) r)
<br />IDf!!. 01 . 2tfh:Jvt1l1/\ ~.
<br />
<br />/JOB ADDRESS
<br />
<br />Fee Simple Titleholder Address I
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<br />! W06"J
<br />I
<br />
<br />33tJ '-I /
<br />
<br />SUBDIVISION
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<br />IDf! .sf.) ')~pl1!jrh"II).J r:-p;
<br />
<br />I PARCEL ID#I
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<br />D NEW CONSTR D ADD/AL T D
<br />D INSTALL D REPAIR
<br />D SFR D COMM D OTHER
<br />D BLOCK D FRAME D STEEL D OTHER I I
<br />
<br />I REmove f.xisfill~ +et1ee f1.J/.d !<ifh~~ f.{),ifl Ileu) ((JifC/1I01
<br />I SQ FOO;AGE 16m~vft- /901' HEIGHT I I
<br />
<br />LOT #
<br />
<br />(OBTAINED FROM PROPERTY TAX NOTICE)
<br />SIGN D MOVE D
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<br />DEMOLISH
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<br />WORK PROPOSED
<br />
<br />PROPOSED USE
<br />TYPE OF CONSTRUCTION
<br />
<br />/ DESCRIPTION OF WORK
<br />
<br />I
<br />
<br />BUILDING SIZE
<br />11'11111"1111'1111111'1111111111111111111111'.11111'111111'11111"111111'1111111111111111111111111111111111'11111111'11'1111111111111'11111111111
<br />D BUILDING / 1$ I ~m I DO appfO'I VALUATION OF TOTAL CONSTRUCTION
<br />
<br />1$ I
<br />1$ I
<br />1$ I
<br />
<br />D GAS D ROOFING D SPECIALTY D OTHER
<br />FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO
<br />
<br />11111111111I111111111111111111111I1111I11111111111I111I1111111111111111111111111111111I111111111111111111111I1111I11111111111111111111111111111111
<br />
<br />:~:::=J~~tr ~~~7/~,~:;R~~ YIN
<br />
<br />
<br />
<br />ELECTRICIAN I COMPANY
<br />SIGNATURE . REGISTERED Y / N FEE CURRENT Y / N
<br />
<br />D ELECTRICAL
<br />D PLUMBING
<br />D MECHANICAL
<br />
<br />AMP SERVICE
<br />
<br />D
<br />
<br />PROGRESS ENERGY
<br />
<br />D
<br />
<br />WR.E,C,
<br />
<br />VALUATION OF MECHANICAL INSTALLATION
<br />
<br />Address
<br />
<br /> License #
<br />Y/N FEE CURRENT
<br /> License #
<br />Y / N FEE CURRENT
<br /> License #
<br />Y/N FEE CURRENT
<br />
<br />PLUMBER
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />Address
<br />
<br />MECHANICAL
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />Address
<br />
<br />OTHER
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />License #
<br />1111111111111111111111111111111111111I1111111111111111111111111111I111111111111111111111111111111111111111111111111111111111111111
<br />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 wi Silt Fence instal/ed,
<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 onsite, Construction Plans, Stormwater Plans w/ Silt Fence instal/ed,
<br />Sanitary Facilities & 1 dumpster, Site Work Permit for al/ new projects, AI/ commercial requirements must meet compliance
<br />Attach (2) sets of Engineered Plans,
<br />....PROPERTY SURVEY required for al/ NEW construction,
<br />
<br />DI~~~ii~~~': ' , , , , , . . , . . . , . . . , . . , , , . . . , . . . , , , , . . , , , , . . , , , . . , , , . . , , . . . , , . . . , , , . . , . , , , , . , , . . , , , . . , , , , , . . , , , , , , . , . . . , , , , , , . . . . . . , , , . . , , , . , , , , , , , , , , , , . ,
<br />
<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)
<br />
<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 AlC Fences (Plot/Survey/Footage)
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<br />Address
<br />1111/1111111111
<br />RESIDENTIAL
<br />
<br />COMMERCIAL
<br />
<br />SIGN PERMIT
<br />
<br />Driveways-Not over Counter if on public roadways.,needs ROW
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