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<br />813-780-0020
<br />
<br />City of Zephyrhills Permit Application
<br />Building Department
<br />
<br />Fax-813-780-0021
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<br />,
<br />Date Received
<br />
<br />
<br />Ih" /III ~
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<br />
<br />Owner Phone Number
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<br />Owner Phone Number I 3(P.3 - ~ 7fjJ'
<br />Owner Phone Number I
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<br />Owner's Name e r -I r 11
<br />
<br />Owner's Address I 5.30 '/
<br />Fee Simple Titleholder Namel
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<br />Fee Simple Titleholder Address
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<br />JOB ADDRESS
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<br />5/tmc.
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<br />LOT #
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<br />WORK PROPOSED
<br />
<br />B
<br />D
<br />D
<br />I
<br />
<br />NEW CONSTR
<br />INSTALL
<br />SFR
<br />BLOCK
<br />
<br />I
<br />B
<br />D
<br />D
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<br />D
<br />D
<br />D
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<br />STEEL D OTHER I For l/lh"~"'71f1 ChlJ.
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<br />PARCEL ID#I
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<br />PROPOSED USE
<br />TYPE OF CONSTRUCTION
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<br />ADD/ALT
<br />REPAIR
<br />COMM
<br />FRAME
<br />
<br />\\-74---2.1-0010- !iqO()- 6(<1~
<br />(OBTAINED FROM PROPERTY TAX NOTICE)
<br />SIGN D MOVE D
<br />
<br />DEMOLISH
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<br />SUBDIVISION
<br />
<br />DESCRIPTION OF WORK
<br />
<br />BUILDING SIZE SQ FOOTAGE I HEIGHT I
<br />'P"'III"'IIII'II'IIIIII'IIII'II'III"II'I"'IIII"II1"1"1111"1'111111'11111"11111111111111111111111'1'1111111111111111"1"11111"1111111111
<br />
<br />D
<br />
<br />1$ I
<br />I$~ow I
<br />D PLUMBING 1$ I
<br />D MECHANICAL 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 />IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII! 1111111I1111111111111I1111111111111111111111111111I11111111111111111111111111I11111111111111111111111
<br />
<br />BUILDING
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<br />VALUATION OF TOTAL CONSTRUCTION
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<br />cr
<br />
<br />ELECTRICAL
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<br />AMP SERVICE D PROGRESS ENERGY D W.R.E.C,
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<br />VALUATION OF MECHANICAL INSTALLATIO~'
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<br />BUILDER
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />YI N
<br />
<br />FEE CURRENT
<br />
<br />Y/N
<br />
<br />Address
<br />
<br />License #
<br />
<br />
<br />~;fllr Dt:'clr-rc
<br />Y I N I FEE CURRENT I Y I N I
<br />
<br />License # I EC-ooc) /2b/
<br />
<br />ELECTRICIAN
<br />SIGNATURE
<br />
<br />~~
<br />
<br />
<br />Address
<br />
<br />PLUMBER
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />FEE CURRENT
<br />
<br />Y/N
<br />
<br />COMMERCIAL
<br />
<br />Address
<br />
<br />MECHANICAL I
<br />SIGNATURE .
<br />
<br />Address I
<br />
<br />OTHER I
<br />SIGNATURE
<br />
<br />Address I License #
<br />II11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111I111111111111111111
<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 wI 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 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 />
<br />License #
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y I N
<br />
<br />FEE CURRENT
<br />
<br />Y/N
<br />
<br />License #
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y I N
<br />
<br />FEE CURRENT
<br />
<br />Y/N
<br />
<br />SIGN PERMIT
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<br />DI~~~ti~~~': . . , , . . . . . , , , . . , . . . . , . , . . , , . . . , , , . . . . , . . . . , . . . , , , . . . , . . . . , . . . . . , , , . . , , , . . . . , . . . . . . , '. . . , , , , . . . . , , , , , , , , , , . , . . , , , , . , . . . , . , . . , . , . . . . . , , , , . .
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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 AlC Fences (PloVSurvey/Footage)
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<br />Driveways-Not over Counter if on public roadways..needs ROW
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