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<br />fV' <br />~\ 8'3-_ <br /> <br />~6~ <br /> <br />, <br /> <br />City of Zephyrhllls Permit Application <br />BuIIcllng Oepertment <br /> <br />Fax-813-780-0021 <br /> <br />Date Received <br /> <br /> <br /> <br />.os <br />Own".p~ Number <br /> <br />Owner Phone Number I <br />133634 I <br />Owner PI10M Number <br /> <br />Owner's Name <br /> <br />Owner's Address 5439 <br />Fee Simple TItleholder N~ I <br /> <br />Fee Simple Titleholder Adcfreee I <br /> <br />~05t.l <br /> <br />WORK PROPOSED <br /> <br />~ <br /> <br />NEW CONSTR <br />INSTALL <br />SFR <br />BLOCK <br /> <br />~~~MC&~r-f26-2t-~O(PO- ~~~~/ 3 <br /> <br />(OBTAINED FROM PROPERTY TAX NOTICE) <br />D SIGN 0 MOVE D <br /> <br />o <br />D <br /> <br />JOB ADDRESS <br /> <br />Silvera&> <br /> <br />SUBDIVISION <br /> <br />PROPOSED USE <br />TYPE OF CONSTRucnON <br /> <br /> <br /> <br />E3 <br />D <br /> <br />DEMOLISH <br /> <br />ROOFING <br /> <br />I <br />I <br />I <br />I <br />CJ <br />I <br /> <br /> <br />- <br /> <br />~ Single Famil . Residence <br /> <br />BUILDINGSIZE ~")c. I 8QFOOTAGE I ~CJ~ I <br /> <br />1$ 71100 <br /> <br />1$ 6~5 ~ <br /> <br />1$ 57<6/ <br /> <br />1$ 6~f::O <br />D GASD <br />FINISHED FLOOR ElEVAnONS IIO~... ~ <br /> <br />DESCRIPTION OF WORK <br /> <br />o <br /> <br />BUILDING <br /> <br />ELECTRICAL <br /> <br />VALUATION OFTClTAL ~/ <br />AMPS~CE . PROGRESS ENERGY <br /> <br />D WRE.C. <br /> <br />{'JDG -j <br />~DjjJ ~ <br /> <br />D <br />o <br />D <br /> <br />PLUMBING <br /> <br />MECHANICAL <br /> <br />VALUAnON OF MECHANICAL INSTALLAnON <br /> <br />SPECIALTY D <br />FLOOD ZONE AREA <br /> <br />OTHER <br />DYES <br /> <br />)'ZINO <br /> <br />Addr... <br /> <br /> <br />Address <br /> <br />COMPANY I ~ Hanes ~ <br />ReGI8'rBMD 1M N I FEE CURRENT I (YJIN I <br />3634 Ucense.# I C8C1252865 <br />COMPANY r-s:i S Electric Co. . . <br />- ~N I '''~NT ~ I <br /> <br />Ueens.# lP.Rnnnn~OA~ <br /> <br />~ ", .:~""" eN I <br /> <br />Ueense # IC"c.. ()S I-] 56 Lf <br /> <br />~f~~~ <br /> <br />Ueense# l!.CAC057517 _ <br /> <br />COMPANY I <br />AHt8TlMD Y 1 N FeE CUItR!NT Y 1 N <br /> <br />BUILDER <br />SIGNATURE <br /> <br />ELECTRICIAN <br />SIGNATURE' <br /> <br />Add,.... <br /> <br />PLUMBER <br />SIGNATURE <br /> <br />Addr... <br /> <br />MECHANICAL <br />SIGNATURE <br /> <br />Addre.. <br /> <br />---1 <br />I <br />I <br /> <br />OTHER <br />SIGNATURE <br /> <br />Ueen.. # <br /> <br />RESIDENTIAL <br /> <br />Attach (2) Plot ....ne: (2) uta Of Building Plana; (1) .. Of I!nefgy Porm. <br />MInimum ten (10) WOl'ldng d.-ya aftw submittal d..., "equlred onll., Conatl'uctlon Plene, S8nltary Pecllltl.. & 1 dump.ter <br />AttMh (I) .... of 8ulIdlno Plene; (1) .et Of Bnercw JIorme, <br />Minimum ten (10) WOI'Idng d.-yalfter eubmlttal de., FtequlNd oneIte. Construotlon Plene, SenltelY Pec/Ilt1.. & 1 dumpster <br />All OOl'/'JmeraIaI ~ muat meet compll.nca. <br />Attach (2) .... Of Enatneered ....n.. <br />""""PROPIIR 8URVEY required for ell NIIW oonetruolIon. <br /> <br />- <br /> <br />COMMERCIAL <br /> <br />SIGN PERMIT <br /> <br />Directions: <br />Fill out application compIeIeIy. <br />Owner & ContrIIclIot tICln black Of application, notarlzed <br />If over $2500, a NotIoe of Cornmenoement I. required. (Ale uporadH over $8000) <br />Agent (for the contracllot) tJt Poww of Attomey (for the OWIW) would be IOmeorle with notarl%ed letter from owner authorlzlno ..me <br />:lVER THE COUNTER PI!lUltTTlNO (Front Of Application Only) <br />Reroofs Sewers Service Upgrades Ale Penoes (PlotISurveylFoot8ge) <br /> <br />Drivewa~ over Counter If on public roadways..needs ROW <br /> <br />....-- <br />