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813-780-0020 City of Zephyrhill Permit Application Fax-813-780-0021 <br /> -- Building epartment <br /> Date Received phone Contact for ermitting — <br /> Owner's Name ��� f� Owner Phone Number <br /> Owner's Address � � �(—1 � t �1 � Owner Phone Number <br /> Fee Simple Titleholder Name Owner Phone Number <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS —1 l I S���C'— � LOT# � <br /> SUBDIVISION W11�S � � PARCEL I # • (� • 21 '��LO� + �.!'�VZO <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED e NEW CONSTR e ADD/ALT � SIGN Q Q DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SFR Q COMM � OTHER <br /> TYPE OF CONSTRUCTION Q BLOCK Q FRAME Q STEEL Q <br /> DESCRIPTION OF WORK DO� <br /> !�/�/� /'�:"'" <br /> BUILDING SIZE SQ FOOTAGE O'W HEIGHT / � <br /> � <br /> OBUILDING $ VALUATION O TOTAL CONSTRUCTION 5�'��� ' <br /> DELECTRICAL $ AMP SERVICE Q PRO � S-E-N GY Q' W.R.E.C. <br /> OPLUMBING $ � <br /> QMECHANICAL $ VALUATION O MECHANICAL INSTALLATION �� <br /> l <br /> GAS ROOFING SPECIAL OTHER � <br /> FINISH�ED FLOOR ELEVATION� � FLOOD Z NE A�REA YES NO �J� � <br /> 0 � <br /> BUILDER COMP NY <br /> SIGNATURE REGIST RED Y/ N FEE CURRE� Y/N <br /> Address ' License# <br /> ELECTRICIAN CONiP NY <br /> SIGNATURE REGIST RED Y/ N FEE CURRE� Y./N <br /> Address License# <br /> PLUMBER COMP NY <br /> SIGNATURE REGIST RED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> MECHAPIICAL COMP NY <br /> SIGNATURE REGIST RED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> OTHER COMP NY <br /> SIGNATURE �� f2EGIST RED Y/ N FEE CURRE� Y/N <br /> Address X ��J'J� ['� License# G� <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of nergy Forms;R-O-W Permit for new wnstruction, <br /> Minimum ten(10)working days_after submittal date.-Requ red_onsite,Construction Plans,Stormwater Plans w/Silt�Fence-installed;- --� -- <br /> Sanitary Facilities&'I�dumpster;Site Work Permit for subd visionsllarge projects _ t� � <br /> COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safe Page;(1)set of Energy Forms�R-O-W Permit,for new construction. <br /> -- Minimum.ten(10).working days•after submittal date. Requ red onsite,Construction Plansi Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities&1'dUmpste�.Sit'e,Work"Fermit for all n w projects.All commercial requirements'mrfs�tlneet�cdri�pliahce <br /> SIGN PERMIT Attach(2•)s�ts of Enqineered�Pla[�s. 6 .•_ s ��; ,,-. „, �.. 1,� a .,�:`i^ ' � 3 7 ?�ti_t�• <br /> '***PROP�R�-Sl1RV�:Y req'fi'i�ed.for_alkN�W constr"u�tio t'� '�3.�: ;G'�,�`�; ;._, +t-._;.-.a-•`._� 'i- 5`� � , + <br /> Directions: � -` • � <br /> Fill out application completely. <br /> Owner&Contractor sign.back of ap�licatiop,notarize� j � ,, . _, '; , <br /> If over$2500,a Notice q�'�orhmenee�7 ent.is r.e uired. A/C u� � over$7500 ' n �' � � ?� ' i �+ �: <br /> .4 ti F,,o' ��.f, "._.�. q` P9k� ,y,y��� `t' � �� .1 ��; �+",�':ryo j. S ,,.�i ���• 7e��� t``.- <br /> .* P � '�° �. �d.-��, . �. 4�,� ���-. <br /> Agent(for the contracto�)orrPowe�Tpf Pfttomey(fof ttie o`wri�r)�v�oulil`be�s�`heone with notarized letter from ovimer au�honzing same <br /> OVER THE COUNTER PERMITi'ING � (Front of Application Only) �`� <br /> Reroofs if shingles Sewers Service Upgrades A/C Fences(PI t/Suivey/Footage) �. , <br /> ,_ - •- _ . . <br /> Driveways-Not over Counter if on public roadways..needs ROW � - � <br /> !�.. , . , . - " _ . - <br /> ,..:� , , „ „ �, _ , _ . <br />