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, 813-780-0020 City of Zephyrhills Permit Application Fax-sl�-�ao-oozi �� <br /> Building Departm " �'� <br /> Date Recaived phone Contack f Pertni � �� D J� <br /> Tf T <br /> OwnersName JSA Healthcare Corporation ownerPhoneNumber �2�-824-0780 <br /> OwnersAddress 10051 Sth Street N, Suite 200 OwnerPhoneNumber , <br /> Fee Simpla Titleholder Name Owner Phone Number <br /> Fee Simple Titleholder Address <br /> JOBADDRESS 5528 Gall Boulevard LOT# � <br /> SUBDIVISION � PARCELID# 11-26-21-0010-05700-0250 <br /> (OBTAMED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED e NEW CONSTR e ADD/ALT Q SIGN Q Q DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SFR Q COMM � OTHER <br /> TYPE OF CONSTRUCTION Q BLOCK � FRAME � STEEL Q <br /> DESCRIPTIONOFWORK Medical office built out. <br /> BUILDINGSIZE EX1St1Ilg SQFOOTAGE 2000 HEIGHT EX1St1Rg � <br /> TTrI"rITfTTr T TTr� <br /> �BUILDING $ �� � VALUATION OF TOTAL CONSTRUCTION �j <br /> �ELECTRICAL $ AMP SERVICE � PROGRESS ENERGY Q W.R E.0 / <br /> � !#�rl� <br /> X�PLUMBING $ C�' ��� �� � <br /> �MECHANICAL $ VALUATION OF MECHANICAL INSTALLATIGp � �� <br /> �GAS Q ROOFING Q SPECIALTY � OTHER <br /> FINISHED FLOOR ELEVATIONS EXi St i71g FLOOD ZONE AREA OYES X NO <br /> ��..-r.-.-r..-....--^-�-i i-i •-r' ^ • i • .�.�-•-•--•�-•--•--•-'-i-i-%'�i• <br /> BUILDER r� COMPANY Bollenback BUild2r5, IriC. <br /> SIGNATURE L�6IGZERED Y/ N FEE CURRE� Y/ N <br /> Address 160 SCarlet Boulevard, Oldsmar �icense# CGCO23973 <br /> ELECTRICIAN i i r COMPANY J I"`T� �" T�� � �C. N t� <br /> SIGNATURE � REGISTERED Y/ N FEE CURREf. Y! N <br /> Addrass � 5 W�S �-'r �Ul� C.�' f'Z. License #�L�� Z 3� <br /> ���; <br /> PLUMBER COMPANY I D q kM /� �/ D�. Bk � •` g"�' �,��' <br /> i /G • /►��Q <br /> SIGNATURE REGISTERED Y N FEE CURRE� N j/� I/� <br /> u Il <br /> Address �� Z � � � C � � License # C � _l Z � � �$ <br /> MECHANICAL COMPANY DI� r Jf f�/`�//u LLC <br /> SIGNATURE REGISTERED Y I FEE CURRE� Y/ <br /> Address ,3 f � f Q License # ��7 <br /> OTHER COMPANY <br /> SIGNATURE REGISTERED Y I N FEE CURRE� Y/ N <br /> Address License # <br /> 1111111111111111111111111111111111111111111111111111111111111111111 <br /> RESIDENTIAL Attach (2) Pbt Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permd for new construction, <br /> Minimum ten (10) working days after submdtal date Requued onsite, Construchon Plans, Stormwater Plans w/ Silt Fence installed, <br /> Sanitary Facilities & 1 dumpster, Site Work Permit for subdiwsions/large pro�ects <br /> COMMERCIAL Attach (3) complete sets of Bwlding 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. Reqwred 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 all NEW construction. <br /> t• <br /> Directions: • <br /> Fdl out application completely <br /> Owner 8 Contractor sign back of application, notarized <br /> If over 52500, a Notice of Commencement is required. (A/C upgrades over f7500) <br /> " Agent (for the contractor) or Power of Attomey (for the owner) would be someone with notarized letter from owner authorizing same <br /> OVER THE COUNTER PERMITTING (Front of Application Only) <br /> Reroofs if shingles Sewers Service Upgrades A/C Fences (PIoUSurvey/Footage) <br /> Driveways-Not over Counter if on public roadways..needs ROW <br />