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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 />.it' go3o
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<br />Date Received
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<br />Owner's Name SJ!f"u.~,q 1Jzn-n'l'r tJ
<br />Owner's Address I S5'/ I / / rA SI.
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<br />Fee Simple Titleholder Namel
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<br />f' 11J"'~sAI9 1.
<br />~-S- 2~p4"),,i/s fl. 335--1.;..1
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<br />Fax-813-780-0021
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<br />Owner Phone Number
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<br />Owner Phone Number I
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<br />Owner Phone Number I
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<br />Fee Simple Titleholder Address
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<br />JOB ADDRESS 55// //rtsi. 2t!!.JtJ~rh Ii/.; Fl. 33.5712- LOT #
<br />SUBDIVISION I PARCEL ID#I //-~(,-';<I-~tJlt)- /I~/J() - dd7tJ
<br /> (OBTAINED FROM PROPERTY TAX NOTICE)
<br />WORK PROPOSED E3 NEW CONSTR B ADD/AL T D SIGN D MOVE D DEMOLISH
<br /> INSTALL REPAIR
<br />PROPOSED USE D SFR D COMM D OTHER I
<br />TYPE OF CONSTRUCTION D BLOCK D FRAME D STEEL D OTHER I
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<br />DESCRIPTION OF WORK r j19u S ~ '1/1 c:. c d
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<br />BUILDING SIZE HEIGHT I
<br />111'111"'111"11'1'11111'111'1""1"'111'1"'11"1111111'111'1'11111'111"1111"'1111"'1111"111"'111"111"'11111"'1111'1'11111111"111"111
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<br />1$ I
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<br />D ELECTRICAL 1$:51JlJ ,00 I
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<br />D PLUMBING 1$ I
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<br />D MECHANICAL 1$ I
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<br />D GAS D ROOFING D SPECIALTY D OTHER
<br />FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNo
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<br />11111111111111111111111111111111111111111111111111111I1II11111111111111111111111111111111111111111111111111111111I11I11111111111111111111111111111
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<br />D
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<br />BUILDING
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<br />AMP SERVICE
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<br />VALUATION OF TOTAL CONSTRUCTION
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<br />PROGRESS ENERGY
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<br />D
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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 />Address
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<br />MECHANICAL I
<br />SIGNATURE .
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<br />Address I
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<br />OTHER I
<br />SIGNATURE
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<br />Address I License #
<br />11111I1I111I1111111111111111111111111111111111111111111111111111111111111I111111111111111111111111111111111111111111111111111111111111111111111111
<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 w/ 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 w/ 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 />BUILDER
<br />SIGNATURE
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<br />COMPANY
<br />REGISTERED
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<br />Address
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<br />ELECTRICIAN
<br />SIGNATURE
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<br />Address
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<br />PLUMBER
<br />SIGNATURE
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<br />COMPANY
<br />REGISTERED
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<br />COMPANY
<br />REGISTERED
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<br />COMPANY
<br />REGISTERED
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<br />COMMERCIAL
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<br />SIGN PERMIT
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<br />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 />I ~-fh ~ EI~cIrJ~
<br />I Y / N I FEE CURRENT I Y / N
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<br />License # I EC ()(J1.2(,8
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<br />;P,1,3 7
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<br />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 />Y / N
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<br />Y/N
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<br />FEE CURRENT
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<br />License #
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<br />Y/N
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<br />FEE CURRENT
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<br />Y/N
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<br />Di~~~ij~~~': . , , . . . . . , . . , , , . . , . . . , , , . . , , , . . , , , . . . , . , . . , . . . . , , . . . . . . , , . . . . , , . , . . , , . . . , , . . . . , , . . , , , . . , . , . . , . . , , . , , , . . . . . . , . , , , . . , . . , , . , , . , , . , , , , , , , , , .
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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 (PloUSurvey/Footage)
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<br />Driveways-Not over Counter if on public roadways..needs ROW
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