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°"-/O1"w"' c:ity ot[ephyrhills Permit Application Fax-813-760-OC <br /> Building Department <br /> Date Received .�'..- Z�� �/,j � __ !C,��lr <br /> Phone CoMact for Permittin • - Z �i <br /> Owner's Name �IIJ IV Q,l,� Owner Phone Number ��3 '�7�JL -C��S <br /> Owner's Address � (� � � ' �t. `'1 (Ll�c pNmer Phone Number �(3 � ��L{ � �C((� <br /> Fee Simple Titleholder Name i('Y1 F}- 0��-CQa,�L-�-� Owner Phone Number <br /> / Lf CO►�� <br /> Fee Simple Titleholder Addresa �C��I�� �(,�% �j'� �,i � �r� , �'i ���� �'� ��S'�� .t,�-(� ,/ <br /> �'` � <br /> °-� ,�,,�r 1 <br /> JOB ADDRESS t F � - ��S �)pp,� �t ('Z L� �° � �'1 (�,, S LOT� �� Z�C.J ; �� <br /> SUBDIVI310N � ��-(��p PARCEL ID�R b � � ' �j3QU -ppOc�a --DaO� <br /> �OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED � NEW CONSTR 8 ADD/ALT � SIGN Q [� DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SFR �] COMM �� OTHER <br /> TYPE OF CONSTRUCTION � BLOCK Q FRAME � STEEL Q <br /> DESCRIPTION OF WORK ' 1�,� �QVI�a�L�—t,o y� <br /> BUILDINt3 SIZE �4� �S � $Q FOOTA(3E �G��p <br /> HEI(iHT <br /> ��BUILDING a t� � ,� VALUATION OF TOTAL CONSTRUCTION � �C..����/ <br /> Ti � 3 <br /> [�ELECTRICAL a AMP SERVICE PROGRESS ENERGY Q�(�R E.C. <br /> � <br /> �PLUMBING s <br /> �� ac� �2 �r�r,/ <br /> [�]MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION ���`' y l✓ <br /> �, �J�Pi � C�� ?i� <br /> QGAS Q ROOFING SPECIALTY �] OTHER � S, � �l�'^� �y <br /> f..�''��� <br /> F I N I S H E D F L O O R ELEVATIONS FLOOD ZONE AREA QYES NO <br /> BUILDER COMPANY 1 1 �'►4 S�C'C`1U d.� _� <br /> SIGNATURE - REGISTERED / N FEE CURRE� Y/N <br /> Address 3(Q (, rj 4 -�.(�h v r�r��s �( License# r�'�- ������d� <br /> ELECTRICIAN COMPANY � 1"t��� °l1 �1C�.�.`c�'�.��. <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address � �6b .Fy,�' �A-n� �,l �(-�j 3 s�� License# E �. 13�013�� <br />� �i 7; -�;q�( Ba t�z (� 1 t_ `_ <br /> RE MPANY'' Z.J b`�`�l�A� lti.v✓l�] c �7 <br /> � REGISTERED Y/ N FEE CURREP Y/N <br /> Address l.�� ���t! � R�Ai ' l �t. �S��u� _ License# �, � <br /> _.....__ _..........__. � <br /> MECHANICAL '"�/ COMPANY ��+V � `w <br /> SIGNATURE -�-�� REGISTERED Y/ N FEE CURRE� Y/N <br /> Address ���j �� 3����/}-(� � License# �-�C " �z��3Ce b <br /> OTHER COMPANY C�--- <br /> SIGNATURE REGISTERED / N FEE CURRE� Y/N <br /> Addresa '3 S� �" �k 2rl t � License# e�� ��� S�� � <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 aRer submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary FadBdes d�1 dumpster;Site Work Permit for subdivisions/large proJects <br /> COMMERCIAL Attach(3)complete sets of Bullding Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction. <br /> Minimum ten(10)working days aRer s�mittal date. Required onsite,Constructlon Plans,StoRnwater Plans w/Silt Fence installed, <br /> Sanitary Fadlities 8 1 dumpster.Site Work Pertnit for all new projects.All commercial requirements must meet compeance <br /> SIGN PERMIT Attach(2)sets of Engineered Plans. <br /> �w�wPROPERTY SURVEY requlred for all NEW constructlon. <br /> DirecHons: <br /> Fill out applicatlon completely. <br /> Owner 8 Contractor sign back of applicatlon,notarized <br /> If over i2300,a Notice of Commencement is required. (AIC upgredes over 57500) <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 ApplicaUon Oniy) <br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(Plof/Survey/Footage) <br /> Drivewsys-Not over Counter if on public roadways..needs ROW <br />