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<br />81 :3-780-0020
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<br />Date Received ' ., q- cJ'J
<br />'R IJJ PtJ}J;E V E.5"eJR/
<br />Owner's Address 1$ 9 ~ LJ2 11 ~/lE ;/-1 y ~ T WAY
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<br />Fee Simple Titleholder Namel '
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<br />City of Zephyrhills Permit Application
<br />Building Department
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<br />Owner Phone Number 25/3-
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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
<br />
<br />
<br />JOB ADDRESS
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<br />
<br />~
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<br />I
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<br />D NEW CONSTR m ARDE~ 0
<br />D INSTALL D ~
<br />PROPOSED USE 0 SFR D COMM 0 OTHER 15/0t< AG/3.
<br />TYPE OF CONSTRUCTION 0 BLOCK [)tl FRAME 0 STEEL D OTHER I
<br />
<br />DESCRIPTION OF WORK IENClo5t f)<I5TfJl?- C:;Cl(p~/y RtJ~ rOR .3/01016E
<br />
<br />BUILDING SIZE I / d I X :J 0 I I SQ FOOTAGE I ~ Lf () I HEIGHT I / t/ /
<br />1IIIIIIIItllllllllllllllllllllllll'II'II'IIII'I'IIIII'1IIItlll,IIII,IIIII"'IIII,I.'IIIIIIIII"IIIIIIIIIIIII11'11"PIIIIII"llllp11111..III..III..
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<br />l$pc2 be? 00
<br />
<br />D ELECTRICAL 1$
<br />
<br />D PLUMBING 1$
<br />
<br />D MECHANICAL 1$
<br />
<br />D GAS 0
<br />FINISHED FLOOR ELEVATIONS I
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<br />WORK PROPOSED
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<br />SUBDIVISION
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<br />(OBTAINED FROM PROPERTY TAX NOTICE)
<br />SIGN D MOVE 0
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<br />DEMOLISH
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<br />COMMERCIAL
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<br />;J?r~rn (/)- cp(...4/diL '#V?1/40~t
<br />I YI N I I'FEECURRENi-'-~/N(r
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<br />License # I I
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<br />ELECTRICIAN I COMPANY I
<br />SIGNATURE , REGISTERED Y I N FEE CURRENT Y I N
<br />
<br />Address I License # I
<br />
<br />PLUMBER I COMPANY I
<br />SIGNATURE , REGISTERED Y I N FEE CURRENT Y I N
<br />
<br />Address I License # I
<br />
<br />MECHANICAL I COMPANY I
<br />SIGNATUR,E REGISTERED Y I N FEE CURRENT Y IN
<br />
<br />Address I License # I
<br />
<br />OTHER I COMPANY I
<br />SIGNATURE , REGISTERED Y I N FEE CURRENT Y IN
<br />
<br />Address I License # I
<br />1111I11111111111111111111111I111111111111111111111111111I111111111111111111I1111111111111111111111111111111111111111111111111111111111111111111111
<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 fur subdlvisions/iarge 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 />~
<br />I
<br />I
<br />I
<br />D
<br />I
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<br />AMP SERVICE
<br />
<br />BUILDING
<br />
<br />VALUATION OF TOTAL CONSTRUCTION
<br />
<br />ROOFING
<br />
<br />SPECIALTY 0
<br />FLOOD ZONE AREA
<br />
<br />D PRO~E~~~~~
<br />(j2) 1\"g.-1, ~ ~~ t>preouaD ~
<br />ft1~( C:;peC5
<br />"Dc>o.,'?~ J /
<br />tJ.),~o~ -
<br />DNO ~CC - Nlr.. .
<br />
<br />OTHER
<br />DYES
<br />
<br />VALUATION OF MECHANICAL INSTALLATION
<br />
<br />~ BUILDER
<br />SIGNATURE
<br />
<br />SIGN PERMIT
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<br />Di~~~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)
<br />
<br />.. Agent (for the contractor) or Power of Attomey (for the owner) would be someone with notarized letter from owner authorizing same
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<br />'OVER THG r..OllNTca DCD................
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