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<br />813-780-0020
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<br />City of Zephyrhills Permit Application
<br />Building Department
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<br />Fax-813-780-0021
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<br />1f 15k 1
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<br />Owner's Address
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<br />Fee Simple Titleholder Namel ~ ~ o.-t--B--Lo...t
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<br />Date Received
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<br />OWner.s Name
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<br />F.. Simple 11I1.ho1de, Add",.. ~ -.
<br />JOB ADDRESS 1 S 7 (] ::l
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<br />WORK PROPOSED
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<br />~3"{~'? S1 c:fJf~ 0~j;1
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<br />1 PARCELID#\ 3' ' r:L~ '21 OO(}C) (JCJ3C1o 0/00
<br />(OBTAINED FROM PROPERTY TAX NOTICE)
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<br />n:::::r- NEW CONSTR 8 ADD/ALT 0 SIGN 0 MOVE 0
<br />D INSTALL REPAIR
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<br />PROPOSED USE 0 SFR 0 COMM 0 OTHER I I
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<br />TYPE OF CONSTRUCTION 0 BLOCK 0 FRAME ~ STEEL 0 OTHER I, I
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<br />;,~;~~;.~~~~.I~.~ f..~~~~pC~~~.;JfJ. ,~~~~ ~..L "..".."..,......~
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<br />o BUILDING 1$ I{; 1 '1 () -'1Zf2ls: VALUATION OF TOTAL CONSTRUCTION
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<br />o ELECTRICAL 1$ I AMP SERVICE 0 PROGRESS ENERGY
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<br />o PLUMBING l$ I
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<br />o MECHANICAL 1$ I
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<br />o GAS 0 ROOFING 0
<br />FINISHED FLOOR ELEVATIONS 1 I
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<br />LOT #
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<br />SUBDIVISION
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<br />DEMOLISH
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<br />D
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<br />W.R.E.C.
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<br />VALUATION OF MECHANICAL INSTALLATION
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<br />SPECIALTY 0
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<br />FLOOD ZONE AREA
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<br />OTHER
<br />DYES
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<br />DNO
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<br />Address
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<br />I Ob--r, G, ,
<br />~m~arr I~
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<br />License # I
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<br />BUILDER
<br />SIGNATURE
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<br />ELECTRICIAN
<br />SIGNATURE
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<br />1/l.!?~
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<br />I Y / N
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<br />FEE CURRENT
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<br />Y/N
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<br />License #
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<br />Address
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<br />~
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<br />COMPANY
<br />REGISTERED
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<br />PLUMBER
<br />SIGNATURE
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<br />Y / N FEE CURRENT
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<br />Y/N
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<br />License #
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<br />Address
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<br />MECHANICAL I
<br />SIGNATURE .
<br />
<br />Address I
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<br />OTHER I
<br />SIGNATURE
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<br />...~.......L-
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<br />COMPANY
<br />REGISTERED
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<br />Y / N FEE CURRENT
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<br />Y/N
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<br />License #
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<br />~
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<br />COMPANY
<br />REGISTERED
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<br />, , , , ,~~~~~, ,I" , , , , , , , , "'" , , , , , , , ."", , , , , , , , , "'" . , , , , "'" , , , , , , , , , "" , ,! , , , , , "'" , , , , , , , , , ~':::~, ~" ,!."" , , , , , , , , , , , , , , , , , , , , , , , , , , !
<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 onsile, Construction Plans, StDrmwater Plans w/ Silt Fence installed,
<br />Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects
<br />COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (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 w/ Silt Fence installed,
<br />Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance
<br />SIGN PERMIT Attach (2) sets of Engineered Plans.
<br />....PROPERTY SURVEY required for all NEW construction.
<br />1111111,1111111111111111111111111111111111111111111111I111111111I1111111111111111111II111111111111111111111111111111111111111111II11111111111111111
<br />Directions:
<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 cqntractor) 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 PERMITIING (Front of Application Only)
<br />Reroofs Sewers Service Upgrades AlC Fences (Plot/Survey/Footage)
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<br />Y / N FEE CURRENT
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<br />Y/N
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<br />Driveways-Not over Counter if on public roadways..needs ROW
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