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8�a-�so-oozo City of Zephyrhill Permit Application FaX-$�3-7ag-a42� <br /> 8uiidin Department <br /> Date Received Phone Conta t for Permitting 3-'y'�� S(o7 _ U 1/ � <br /> Owner's Ftame 1 Li {�c � �� �j�`�. �-C Qwner Phone Number g 1� "(p ! —t�'�"3� <br /> Owner's Address 3� !U eCL�cl s� � �,7 � N!. 3 1 (a Owner Phane Number� � <br /> Fee Simple Titleholder Name Owner Phone Number�� � <br /> �`ee Simple Titleholder Address <br /> J08 ADDRESS 3�3 3"�i �c� �+�� ��� �or# � <br /> Si18DiVISiON � _ P CEL ID# d 2��� -Z 1 -�Z�.b -4o c�c,�n -on�� <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED NEW CONS7R A /ALT C] SIGN Q MOVE Q DEMOLISH <br /> e INSTALL e RE AIR <br /> PROPOSEI�USE Q SFR Q C MM d OTHER C S ��. <br /> 7'YPE OF CONSTRUCTION Q BLOCK Q F ME Q Sl"EEL Q OTHER <br /> DESCRIPTiON OF WORK I �{�. Qt..0 � ��- ' J" � { e t"Y�, <br /> BUI�DING 5{ZE C_ � SQ FOQTAGE HEIGHT �� <br /> � BUILDING I$ �� VALUA ION OF TOTAI.CONSTRUCTION <br /> � <br /> � ELECTRICAI. ($ - �� AMP S RVICE 0 PROGRESS ENERGY Q W.R.E.C. <br /> E <br /> Q PI.UMBiNG ($ !� /��/'� �'� <br /> 1 ��" f 7�� <br /> Q MECNANiCAL $ � ��� ,p� VALU !ON QF MEGHANICA�INSTA�tAT10N <br /> [� GAS Q ROOF(NG Q S ECIALTY [� 4THER �� <br /> FWISNED FLOOR ELEVATIONS � � F OOD ZONE AREA [�YES QNO `�',� [ > �J <br /> ��,,, <br /> BUILDER � � !� COMPANY <br /> SlGFtATURE REGISTERED Y i N ��cutz�Er�r Y/N <br /> Address License# ���� <br /> ELECTRICiAN � � � COMPANY <br /> SIGNAI"URE RBGISTEREp Y! N FEE CURRENT Y/N <br /> Address License# � ��� <br /> PLUMBER � � �' COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRENT Y/N <br /> Address License# � ^�� <br /> MECtiANlCAI GOMPANY � 1� m Pn-� � <br /> SIGNATURE REGISTERED Y/ FEE CURRENT Y!N <br /> Address ��Q� �.� ���y+ ��Q b�' � �'r. � �$r� Cicense# ��C, 1�� � �J 1 i <br /> OTHER COMPANY <br /> SIGNAl'URE REGISTERED Y I N FEE CURRENT Y/N <br /> Address License# �� � <br /> RESIDENTlAL Attach{2)Piat Plans;(2)sets of Building Plans;(1)s t of Energy Forms;R-O-W Permit for new construckion, <br /> Minimum ten(10)working days after submittal date. equired onsite,Construction Ptans,Starmwater Ptans w/Silt Fence ins#ailed, <br /> Sanitary Facilities&1 dumps#er,Site Work Permit fo subdivisionsJiarge projec#s <br /> COMMERCIAL Aktach(3)complste seks of Building Plans plus a Life afery Page;(1)set af Energy Forms.R-O-W Permlt for new conskruction. <br /> Minimum ten(10)worici�g days after submittal date. equired onsite,Construction Plans,Stormwater Plans w/Siit Fence installed, <br /> Sanitary�aciliGes&1 dumpster.Site Work Permit fo aU new projecfs.Ail cammetoial requirements must m�et compllance <br /> StGN PERMlT Attach{2}sets of Engineered Plans. <br /> *"**PROPERI'Y SURVEY required for all NEW const ction. <br /> Direct�ons: <br /> Fill out application completely. <br /> Owner&Contractor sign back of appiicatlon,notarized <br /> If over�2500,a Aiat�ce of Commencement ls required. (A!C upgr des aver$5000} <br /> "* Agent(for the contractar}a�Pawer of,4ttamey{far the owner}wou(d someane with notarized Eetter from awner autharizing same <br /> OVER THE COUNTER PERMi7TING (Frant af Applicakion Only} <br /> Reroofs Sewers Service Upgrades A!C ences{Plat/Survey/Faotage) <br /> Driveways.tUo't,'�Ver C�,oun�er if�public raadways..needs ROW <br /> �' ,. , <"�"' � ' . ..';��►�,� <br />