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01/24/2012 10:43 813-806-7089 ADT SECURITY SERUICE PAGE 02/06 <br /> F�aaeaoozo City of Zephyrhills Permit Applicatian F�x'�'�'7B0"0°Z' <br /> BWlding OeparlmeM <br /> o.c.Recewea Pnon.cw,t.ec ro►P�rr�lw S�3 $0 6 _ 7 n`7 ' <br /> Ownor'sN�ne �vcoiLES � <br /> ts WcG Owrrcr Phom N�miber $13 �0�/ ��7 <br /> ���� y�°J(o �� �T Owuer Phona Number <br /> Fee Simple TMlaheld�r Neune Own��P�o^e!�n^b°� <br /> �ee Slmplo 7ltleholda►Addre� <br /> JOBADDRESS 5OU�0 STtI c�7•C LOTf � <br /> SUBDIVISION PARCEL 10M t�"z CB'�l ^n O 1�? -Z (��— O 1 b t7 <br /> pBTAIl�FROM PROPBR'►r Tl17f MdT10E) <br /> WORK PROP�ED B NEW CON57R 8 ADDIAl.7 Q SIGN [] Q DEMCxJSH <br /> INSTALI REPAIR <br /> PROPO8ED USE Q SFR �] COMM Q OTHER 'Vo�-T <br /> TYPE OF GQNS7RUCTION Q BLOCK Q fliAME Q S7EEL Q �f�� <br /> DESCRIPTIONOFINORK �NS+'�+-� 4ow vowtwyE SECuK�r S S'�M �r.f Ex�sv�Nh '�sioE"'�` //, ( <br /> � � �i <br /> BUIWING SIZE SQ FOOl'AGEC� 11E10►It <br /> �BUILDING i VALUATION OF TOTAL CONSTRUCTION <br /> [�ELEC7RICAL S 2�p AMPSERVICH Q PROORESSEN�RGY Q W,R.E.C. <br /> [�PLUM91N0 �� <br /> QMECHAWICAL ; VALUA710N OF MECIiANICAL INSTALLATION <br /> Q� � ROOPING Q SP8CIAL?V [,� OTHER <br /> �INISIiED FLOOR ELEVATIONS FLOOD ZONE AFtEA QY�3 NO <br /> HUILDER I COIMPANY <br /> SIGNATURe � REqsT9tEO Y/N FEE�x1RRE� Y/N <br /> AddRas License# <br /> e�crni �-- � ` coMP�wr �1�t" 5E w,Q.+r7 ��zv 1 c�S � <br /> 8iGNA REC�SrEREO Y I N Fle�a�r Y/N ' <br /> Addross r'�`4'1� W M�wTERg R,� '}�"RMP �- '331Di�1� UI�B'# G'���0 ��Z� <br /> PWAABfiR � COMPANY � <br /> 816NATURE reEC�SrEwEp Y! N �art�n Y!N <br /> Addross LICEft�# <br /> I�CHANICAL I GOMPAMY <br /> SIGNATUR� REC,nSTERED Y! N FEEnuRRE� YIN . <br /> Addre�,4 Ucenee i� � <br /> OTH�R COMPANY <br /> S(ONA7URE �cisr��o Y/ N r�€a1we�� Y/�IV . <br /> Addroas Lk�nse# <br /> RFSIDEN7IAL AtlaCh(2)Plo!PMnc;(2)sels of Buliding Pkns:(1)sat d Enarpy Fomts;R-O-W Pam11t for new aonstruCUon. <br /> MlNmum ten(10)working days s�tx submlttal date. RequNed a+sNe,c:onslnwfion Plans.Slommr+ter Plans w/SNt Fenca InsbMed, <br /> SanHary Fadllqes 8 7 dumpster;SI�Wak Pxmlt to►subdM�lorallaipe proJaats <br /> COAAAIIERCIAL Atbch(3)compkte sstc of Bulmkg Plans plus a Life Safeqr Pape;(1)set at Eneroy Fo►ma.R-d-W Permtt/or new cor�sWctlon. <br /> Minlmum ten(10)workk�p days aRw cubmittal date. Requlred or�slle,Construclian Plens.SbrmwaMr Wero w/Sik Fd�ce kwtalled, <br /> Sanitery FadlMios 8 7 duntpster.Site VMOrIt Permlt Tor all new projeCt6.AII oommercial requNemeMs must meet oompYance <br /> SIGN PERMIT AMach(2)set6 of EnWnexeC PIen9. <br />