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<br /> . 813. 780 -0020 City of Zephyrhills Permit Application %� Fax -813- 780 -0021
<br /> Building Department r
<br /> Date Received.,`''"•.....[,.; l' I # i)
<br /> Phone Contact for Permitting
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<br /> Owner's Name Florida Hospital Zephyrhills Owner Phone Number 813- 230 -9708 cel
<br /> Owner's Address 7050 Gall Blvd. Zep ij .t 11 s, FT, 315 w 4 e 1 Phone Number —'
<br /> Fee Simple Titleholder Name Owner Phone Number
<br /> Fee Simple Titleholder Address
<br /> JOB ADDRESS 7050 Gall Blvd. ,Zephyrhills, FL 33541 LOT#
<br /> SUBDIVISION PARCEL ID#
<br /> (OBTAINED FROM PROPERTY TAX NOTICE)
<br /> WORK PROPOSED NEW CONSTR ADD /ALT 1 1 SIGN I I MOVE 1 I DEMOLISH
<br /> INSTALL REPAIR
<br /> PROPOSED USE I I SFR I 1 COMM 1 1 OTHER I
<br /> TYPE OF CONSTRUCTION I I BLOCK 1 I FRAME 11 STEEL I I OTHER 1 I
<br /> DESCRIPTION OF WORK Fireworks Display
<br /> BUILDING SIZE SQ FOOTAGE HEIGHT
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<br /> I I BUILDING $ VALUATION OF TOTAL CONSTRUCTION
<br /> 1 I ELECTRICAL $ AMP SERVICE I I PROGRESS ENERGY I I W.R -E.C.
<br /> I I PLUMBING $
<br /> I I MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
<br /> efic.,140-te O I J GAS I I ROOFING I I SPECIALTY 1 1 OTHER � 1 V 0 /�
<br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA 1 IYES 1 INO ' 1 1
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<br /> ...... ........
<br /> BUILDER COMPANY
<br /> SIGNATURE REGISTERED ( Y/ N I FEE CURRENT 1 Y/ N 1
<br /> Address License #
<br /> ELECTRICIAN COMPANY
<br /> SIGNATURE REGISTERED I Y/ N I FEE CURRENT 1 Y 1 N 1
<br /> Address License #
<br /> PLUMBER COMPANY
<br /> SIGNATURE REGISTERED 1 Y / N 1 FEE CURRENT 1 Y/ N 1
<br /> Address License #
<br /> MECHANICAL COMPANY
<br /> SIGNATURE REGISTERED 1 Y/ N I FEE CURRENT 1 Y/ N I
<br /> Address
<br /> 0 4..^ /� C'•c License #
<br /> OTHER ` ,7� /;,..�--0_
<br /> it COMPANY
<br /> SIGNATURE , , / �Ar_d 1 GA: E +. / Y / N FEE CURRENT 1 Y / N 1
<br /> wine . .✓ 411 /
<br /> Address Pp Box 149. New Castle, PA 1610 License#
<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 /> 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 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 /> SIGN PERMIT Attach (2) sets of Engineered Plans.
<br /> ""PROPERTY SURVEY required for at NEW construction.
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<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. (A /C upgrades over $5000)
<br /> "` Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
<br /> OVER THE COUNTER PERMITTING (Front of Application Only)
<br /> Reroofs Sewers Service Upgrades NC Fences (Plot/Survey /Footage)
<br /> Driveways -Not over Counter if on public roadways..needs ROW
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