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06/03/2011 09:05 3525674454 MILBAR PAGE 01/07 <br /> — — _ � :�,/ <br /> 813•�90A020 City of Zephyrhilis Permit Application Fax-813•780�0021 <br /> Building Mparlmenl <br /> Data ReceivPd ' � <br /> Phone Cont�ot for PerMIHi <br /> i�r's Name t OMn►er Phone Nwnbor <br /> ow„ers adaress � I 3"1 3 owner Phane Numbx <br /> Fee Simple Tiqeholder Name oamsr Phone Nuri►ber <br /> Fe0 Slmple Titlehokler Addresa <br /> JOB ADDRESS O ' � I,GT N � <br /> i <br /> 3UBDNISION PARCEL IWp <br /> (06TMNEh RROM CRdpERTV 7AX NOTIC6) <br /> WORK PROP08ED e NEW.CONSTR � A�D/ALT �� Q SI�N Q MOVE Q DEMOLISH <br /> IN3TALL R�PAIR <br /> PRQPO$ED USE � SFR Q COMM '[[� 01'HER t p <br /> TYPE OF GON3TFtUC'f10N Q BLOCK FRAME O 3TE6L � OTHER <br /> DESCRIP710N OF WORK � r � � <br /> � � <br /> BUILDING SIZE Sq FOOTAOE HEIGMT <br /> O BUILDING E . ' $ �"�y J 9 4y <br /> S U VA�UATION OF TOTAL CONSTRUC7lON �� `�� , <br /> I <br /> Q ELECTRICAI 3 AMP SERVICE Q PRGfGRESS ENERGY �] W.R.E.C. <br /> � PLUMBING S � <br /> Q MECHANICAL �� VAWATION OF MECHANICAI. INSTAILA�i'ION <br /> � <br /> Q C,AS Q ROOFING Q SPECIALTY Q OTHER <br /> FINISHED FI.00R ELEVATIONS ��I FLOOD 20N� AREA �YES �NO <br /> � <br /> sui�oER � aoa��Mr �il�k (��wh�+�_ iH�, <br /> SIGNATURfi REGISI'�REO ' FEEC Y N I <br /> Addre9s �`J�l � ��) L�CILIQ. �.. �) t3 3 Lixnse'# I�,�( i3�.°JOy'Z. w <br /> ELECTRICIAN COMPkIIY �— <br /> SICiNA7URE ' REGISTERED Y f N i FEE CURrtENr Y I N <br /> Addross I.IC6Ri! i� �� <br /> P1.UMB�R COMPANIf <br /> SIGNATURE RECISTEk6p Y/. N ; FEE CuRR�eNf Y I N <br /> Add�as �g�g� � <br /> MECHANIC/(L � COMPAV�IY <br /> � <br /> :NA7URE REO�r�o Y/ N �e curta�Kr Y 1 N <br /> Addro99 � LIoBItSe # � � <br /> OTHER � CGMPANY <br /> SIGHA7URc � REGIB'EV�D Y/ N FcE CURP,ENT Y/ N <br /> Adtlress I,kense # �� <br /> RESIDEN7fAL Atfach (21 Plot Planc; (2) sets bf BuAMnp Plans; (7) sat of EnprqY F�,prrns <br /> Minimum tan (1D) +�rorkinp d0ys aRer suWnktal dab. Rqqulred onslte, Conatructlon Plans, Sanifary FadNd@5 & 1 dumpafer <br /> GOMMERCIA� Attach (3) sets of BWiding Plans; (1) Set of Enetgy foims. <br /> Minimum te� (10) working days �ttar eubmltbl data. Requlred onahe, Gonstruction Plans, Faclikke a 1 dumpster <br /> All Cenxnaroiol tequirem�nls must mea!'eaompllance, <br /> 510N PERMIT Atlach (2) sels of Enpfneered Wans. <br /> '""PROPERTY SURHEY requWed for all NEW conairuction. � <br /> recllons: <br /> Fill out epp6eatbn complotey. <br /> Ow�er & GoMMOtor sign badc of appticatfon, notaAzed � � "` <br /> M ove};2500, a Mbtica•Ot Commsneamdnt Is roqul►tid. (dUC upgrodas ovar 55tl00) ° <br /> "' AgaM (Por the contrador) or power of Atfomey-(forthe.lnwner) would be someone wlth nocarized letterirom. ownbr authoAzing lame. , , <br /> OVER TME COUNTER PERAAtTTiN6 (Front M AFplication Ony) � <br /> Rorootg Sewcrs ,; "'ServlCe upgretlas " /Y1C Fences (Pbd9urvey/FootAge) ' ' <br /> r <br /> �r9veways-NOt ovar Counler If qn pubBc roadway9..needs•ROW. ° <br />