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4073218917 orlandofax 02:26:03 p.m. 07-28-2011 2/6 <br /> , ai3-�eo-oo2o City of Zephyrhills Permit Apptication Fax-813-780-0021 <br /> Building DeparkneM � <br /> '1Rz-z�� <br /> Date Racalvad phon� Contact fir PertnlUlng � <br /> ��Illlil 11111 <br /> t — i <br /> OwneYs Namr � Y l Owner Phona Numbar <br /> OwneYsAddress � }�f1Op( }�t�G{Ci ��Q aruvr�e� 33 '� Owm►PhoneNumber <br /> FeeSimpk7iWhoWarNamQ ��y � ,..} Own�rPhoneNumber � <br /> .—.��_+ <br /> Fea 5lmple 7itlahotda� Address <br /> JOB AODRESS l(/C �G� C`1 I V C� LOT• � <br /> s�ea�� � P���� a3 - oo � v- ,- <br /> �oer�weu Frtor wewpen riuc nonc� <br /> WORK PROPOSED � NEW cONSrR 8 ADD/ALT Q SIGN Q Q pEMOIISH <br /> INS7ALl REPAIR <br /> PROPQSED USE Q SFR d COMM � OTHER <br /> iYPE OF CONSTRUC710N Q BLOCK � FRAME Q STEEL Q <br /> DESCRIPTION OF WORK d f G�. r <br /> BUILDINf3 SIZE �� SQ FOOTAG@ �� HEIGHT �_`] <br /> 1 1 1 1 � r� 7 1 PI 1 1 1 1! 1 1 1 1 � 1 IT� 1 1 1 1 1 �7 1 ITI � 1 1 � f 1 1 1 1 1 1 1 1 1 1 1 1 7 P'! 7 11TT1TnT*' <br /> �BUlLDING S VALUA170N OF TOTAL CONSTRIfCTION <br /> �ELEC7RICAL S � �� AMP SfRVICE Q PROGRESS E1�RGY Q W.R.E.C. <br /> �PLUMBfNG E •r � �il� /�y��' ���'� <br /> � L.(r� a/ i "1 <br /> QMECHANICAL t VALUATiON OF MECHANICAI INSTALLATION ��� J j z � g � <br /> QGAS Q ROOFING Q SPECIALTY Q OTHER T <br /> FINlSHED FLOOR ELEVATIONS �� FLOOD ZONE AREA QYES NO <br /> BUILDER � COMpANY <br /> SIGNATURE � REGISTERED Y! N F� ctraaEn Y/ N <br /> Addrau License f ��� <br /> EIECTRIGIAN 1 COMPANY ' ` j L{�, � �„ � � �n � . <br /> SIGNAIURE aEasiettEO Y N cuRpv. Y! <br /> Addreas 1 7 �U9 LicenseR �l.y��QI(i �1 O]� <br /> ..� <br /> PLUMBER COMPANY � <br /> SIGNATURE REOIb'TERED Y/ N F� cuw+en • V/� <br /> Address license i � <br /> MECNANICAL COMPAN1f �— <br /> SIGNATURE RE013TERED Y! N FEECURREA Y/N <br /> Addmas �� � <br /> OTHER � � COMPpNY � <br /> SIGNATURE � REOISiERED Y/ N F� CURRE� Y/ N <br /> Address Licenset �—� <br /> �����iii���t���i��ii�������ii���i����������rii�i�i�i�i�������i�i��� <br /> RESIDENTIAL Attach (2) Plot Plans; (2) sets o( 8uil�np Plsns; (1) set ot Energy Forms; R-O-W Permn for new consNuclion, <br /> Minimum ten (10) wurking days aTter suhmittal dafe. Required aisrle, ConstniWon Plans, Srortnweter Pians w/ SA� Fence instalbd, <br /> Sanitary FatiYties 8 1 dumpster; Site Wor1c Permfl /w subtlivisionsAarge proJeets <br /> COMMERCIAL Attach (3) complete sets � Building Plana p�ua a LHe Safety Page; (1) set of Energy Forms. R-O-W PermN for new constructron. <br /> Minimum ten (10) woAci� days afier submXlal date. Required onsite, Coruhuqiai Plans, Stormwater Plena w! SNt Fence inafalled, <br /> Sanitary Fari6fies d 1 dumpater. Si� Work Permit tor all new projeda. All commerdal reqWrements must meet compGance <br /> SIGN PERMIT AttacA (2) sets of Engineered Plans. <br /> ""PROPERTY SuRVEY required for aM NE W wnstnulion. <br /> DErecNons. <br /> Fill out application compktely. <br /> Owner 6 ConVador sign badc ol applicafwn, notahzed <br /> It over i2S00, s Notlae of Commencament Is nquired. (A/C upgwdea avar f7500) <br /> " AgeM (for Ihe conmedar) or PmMer of Attorney (tor the owne� would be someone wilh notarized letler from oaner auttwrizing same <br /> OVER THE COUNTER PERMI?71NG (Front of Applicffiion Onfy) <br /> Reroofs if shingles Sewers Service UpgraOes NC Fences (PIot/Survey/Footape) <br /> Drivewaya-NOt ovar Coimter if on puWic roadways..needs ROW <br />